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Publisher: Elsevier   (Total: 3030 journals)

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Showing 1 - 200 of 3030 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 79, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 22, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 303, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 196, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 21, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 120, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 41, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 18, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 33, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 6, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 20, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 14)
Advances in Pharmacology     Full-text available via subscription   (Followers: 13, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 17, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 1, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 332, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 7)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 14)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 12)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 42, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 304, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 390, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 29, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 36, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 48, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 3, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 7, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 45, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 45, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 47, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 25, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 48, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 174, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 51, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 22, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 32, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 13, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 154, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 7, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 143, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Anaesthesia & Intensive Care Medicine
  [SJR: 0.124]   [H-I: 9]   [52 followers]  Follow
    
   Full-text available via subscription Subscription journal  (Not entitled to full-text)
   ISSN (Print) 1472-0299
   Published by Elsevier Homepage  [3030 journals]
  • Neuromonitoring
    • Authors: Malcolm E. Smith; Martin Smith
      Abstract: Publication date: Available online 7 April 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Malcolm E. Smith, Martin Smith
      Management of acute brain injury is based on a central concept that prevention of secondary hypoxic/ischaemic injury is associated with improved outcomes. While clinical assessment of neurological state remains fundamental to neuromonitoring, several techniques are available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality monitoring have enabled an individually tailored approach to patient management in which treatment decisions are guided by monitored changes in physiological variables rather than pre-defined, generic thresholds. Any impact of monitor-guided therapy on outcomes is entirely dependent on the threshold to initiative intervention and subsequent management in response to change in a particular monitored variable, and these remain undefined in many circumstances. This review describes current neuromonitoring techniques used during the critical care management of acute brain injury.

      PubDate: 2017-04-14T11:54:50Z
      DOI: 10.1016/j.mpaic.2017.02.009
       
  • Pituitary disease and anaesthesia
    • Authors: Vivienne Hannon; Ian Appleby
      Abstract: Publication date: Available online 5 April 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vivienne Hannon, Ian Appleby
      Patients with pituitary gland tumours comprise a significant proportion of the neurosurgical population, making transphenoidal pituitary surgery a relatively common procedure. These patients present unique anaesthetic challenges resulting from hormone hypersecretion, pituitary hypofunction or tumour mass effect. To understand this pathophysiology requires knowledge of normal pituitary anatomy and physiology. Respiratory and cardiovascular sequelae of pituitary tumours also pose anaesthetic challenges. We aim to review the key principles involved in the preoperative assessment, intraoperative management and postoperative care of these patients.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.002
       
  • Management of sub-arachnoid haemorrhage
    • Authors: Kate Sherratt; Ugan Reddy
      Abstract: Publication date: Available online 2 April 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Kate Sherratt, Ugan Reddy
      Spontaneous subarachnoid haemorrhage (SAH) is a neurovascular emergency with sudden onset, which requires rapid recognition and early treatment to minimize the occurrence of serious complications. The most common cause is a cerebral aneurysm, which develops at areas of turbulent flow, especially within the circle of Willis. Initial aims are to provide appropriate resuscitation to the patient and to maintain cerebral oxygenation and perfusion. Anaesthesia involves prompt airway control and precise management of physiological parameters to reduce further neurological injury, such as from re-bleeding or delayed cerebral ischaemia. Once stabilized SAH patients should be admitted to a neurointensive care unit and managed by a skilled multidisciplinary team. Definitive treatment then involves either endovascular coiling or surgical clipping, preferably in hospitals managing high volumes of SAH cases per year. Care should be also taken throughout to avoid non-neurological complications such as infections or venous thromboembolism.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.007
       
  • Clinical neuroprotection and secondary neuronal injury mechanisms
    • Authors: Katharine Hunt; Gahan Bose
      Abstract: Publication date: Available online 31 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Katharine Hunt, Gahan Bose
      Cerebral injury is a common cause of severe morbidity and mortality and is frequently encountered by anaesthetists and intensive care physicians in clinical practice. Insults may arise from a variety of medical and surgical conditions, including stroke, subarachnoid haemorrhage, central nervous system infection, epilepsy, post-cardiac arrest, and traumatic brain injury (TBI). Although the primary damage to brain tissue may be irreversible, aggressive early treatment may limit the ensuing secondary brain injury and reduce the risk of severe disability or death. Neuroprotection involves physiological, pharmacological and surgical interventions, initiated before the onset of ischaemia that can modify the cascade of events that lead to permanent cell damage when left unchecked.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.004
       
  • Reflexes: principles and properties
    • Authors: James Waterhouse; Iain Campbell
      Abstract: Publication date: Available online 31 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): James Waterhouse, Iain Campbell
      The body responds to changing circumstances and environmental threats both consciously and subconsciously. The cognitive response to a physical threat normally involves movement mediated by skeletal muscle. There are a number of control mechanisms ‘hardwired’ into the nervous system that enable muscle systems to respond in an integrated fashion without involving a conscious decision, although the subject is usually conscious of what has happened. These include the stretch reflex, the withdrawal reflex and the crossed extensor reflexes. Muscle spindles, Golgi tendon organs and cutaneous nociceptors provide the sensory input to these reflexes, and muscle spindles also play a role in the control of voluntary movement. The autonomic nervous system controls the internal environment in response to environmental change. It consists of the parasympathetic division, which controls basal and vegetative mechanisms, and the sympathetic nervous system, which controls visceral adaptive responses to any sort of environmental change or threat.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.011
       
  • The brain: functional divisions
    • Authors: Leo Donnelly
      Abstract: Publication date: Available online 30 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Leo Donnelly
      The incompletely separated cerebral hemispheres consist of a thin outer folded cortex of grey matter containing organized neuronal cell bodies and interneurons. Some of the surface convolutions subserve particular sensory or motor functions. Incoming afferent and projected efferent fibres constitute the underlying white matter, which connects different parts of each hemisphere, the hemispheres to each other and (as the corona radiata) to subcortical nuclei, especially components of the deeply-embedded diencephalon and the basal ganglia, and continuing between the latter as the internal capsule to and from the cerebellum and brainstem. Divisions of the diencephalon, the deeper part of the embryonic forebrain, include the epithalamus (pineal gland), the thalamus (connected extensively with the cortex), the subthalamus and the hypothalamus (involved in the autonomic nervous system, limbic system and neuro-endocrine system). The brainstem, consisting of the midbrain, pons and medulla, allows passage of many ascending and descending nerve fibre tracts between the brain and spinal cord, carrying sensory information from and allowing movement of the limbs and trunk. It is also the site of many of the cranial nerve nuclei, through which the brain innervates the head region. It houses the centres controlling vital aspects related to respiration, cardiovascular function and consciousness levels. The cerebellum also has a cortex of grey matter, tightly convoluted into folia, and containing layered neuronal cell bodies projecting laterally and, as underlying white matter, to a collection of deep nuclei. Fibres run to and from the cerebellar nuclei in a series of peduncles to the midbrain, pons and medulla, and allow the cerebellum to coordinate movement at an unconscious level.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.003
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      Abstract: Publication date: Available online 30 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.03.001
       
  • Hypoxic–ischaemic brain injury following cardiac arrest
    • Authors: Robin S. Howard
      Abstract: Publication date: Available online 30 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Robin S. Howard
      Hypoxic–ischaemic brain injury (HIBI) has become an increasingly common cause of admission to intensive care units (ICUs) and prolonged or permanent neurological disability. It is essential to provide an accurate prognosis to guide management. Following restoration of spontaneous circulation (ROSC) clinical assessment is often difficult and ancillary investigation is necessary. Outcome depends on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer, and the post-resuscitation management on the ICU. Some patients remain profoundly impaired and others may develop complications including myoclonic epilepsy, cognitive impairment, border-zone infarction and movement disorders. The management of patients with HIBI presents considerable clinical, ethical and legal difficulties.

      PubDate: 2017-04-07T10:46:27Z
      DOI: 10.1016/j.mpaic.2017.02.005
       
  • Intracranial pressure and cerebral haemodynamics
    • Authors: Ashwini Oswal; Ahmed K. Toma
      Abstract: Publication date: Available online 29 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ashwini Oswal, Ahmed K. Toma
      Intracranial pressure (ICP) refers to the pressure within the skull, which is determined by the volumes of the intracranial contents; blood, brain and cerebrospinal fluid. Monro–Kellie homeostasis stipulates that a change in the total intracranial volume is accompanied by a change in the ICP, which is more precisely described by the intracranial pressure–volume relationship. Maintenance of a relatively constant ICP is essential for maintenance of the cerebral perfusion pressure, which in turn determines global cerebral blood flow. Although the physiological process of autoregulation ensures that cerebral blood flow is tightly maintained over a range of cerebral perfusion pressures, large increases in the ICP can result in severely impaired autoregulation, meaning that cerebral blood flow may be compromised. In this review article we provide an overview of the physiological determinants of the ICP and cerebral blood flow. We go on to illustrate how pathological states can compromise physiological compensatory mechanisms in order to potentially dangerous disturbances of the ICP and cerebral blood flow.

      PubDate: 2017-03-30T09:20:50Z
      DOI: 10.1016/j.mpaic.2017.03.002
       
  • Traumatic brain injury: initial resuscitation and transfer
    • Authors: Michael Puntis; Toby Thomas
      Abstract: Publication date: Available online 29 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Michael Puntis, Toby Thomas
      Traumatic brain injury (TBI) is common and is associated with significant morbidity and mortality. The initial resuscitation and management of patients with TBI is focused on limiting secondary brain injury and this may be complex in patients with significant injuries to other organ systems. The transport of critically ill brain-injured patients for definitive treatment also carries significant risks which must be managed. This review describes the initial resuscitation and transfer of head-injured patients.

      PubDate: 2017-03-30T09:20:50Z
      DOI: 10.1016/j.mpaic.2017.02.006
       
  • Critical care management of adult traumatic brain injury
    • Authors: Michael Puntis; Martin Smith
      Abstract: Publication date: Available online 29 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Michael Puntis, Martin Smith
      Severe traumatic brain injury (TBI) is associated with significant morbidity and mortality. The critical care management of TBI requires a coordinated and comprehensive approach to treatment, including strategies to prevent secondary brain injury by avoidance of systemic physiological disturbances, such as hypotension, hypoxaemia, hypo- and hyperglycaemia and hyperthermia, and maintenance of adequate cerebral perfusion and oxygenation. Management protocols have evolved with international consensus, providing guidelines that assist clinicians in delivering optimal care. Those from the Brain Trauma Foundation are continuously updated to incorporate new trial data (https://braintrauma.org/coma/guidelines).

      PubDate: 2017-03-30T09:20:50Z
      DOI: 10.1016/j.mpaic.2017.02.008
       
  • Cardiovascular system: critical incidents
    • Authors: Amit Goswami; Ruth Spencer
      Abstract: Publication date: Available online 28 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Amit Goswami, Ruth Spencer
      Cardiovascular events are an important group of critical incidents in anaesthesia. They include hypotension, hypertension, myocardial ischaemia/infarction, arrhythmias, and; cardiac arrest. These incidents require prompt recognition and treatment.

      PubDate: 2017-03-30T09:20:50Z
      DOI: 10.1016/j.mpaic.2017.02.010
       
  • Anaesthesia for endoscopic surgery
    • Authors: Michael H. MacMillan; Marie Davidson
      Abstract: Publication date: Available online 9 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Michael H. MacMillan, Marie Davidson
      Anaesthesia for endoscopic airway surgery involves unique challenges. The anaesthetist and surgeon are working in close anatomical proximity and the concept of shared airway is never more relevant. Understanding the planned procedure and the needs of the surgeon for access to the surgical field will enable the provision of anaesthesia and airway management using a variety of techniques. Planning for safe induction, maintenance and emergence of anaesthesia will also be guided by the specific pathology and patient characteristics and requires effective communication between the surgeon and anaesthetist.

      PubDate: 2017-03-11T16:13:30Z
      DOI: 10.1016/j.mpaic.2017.01.006
       
  • Alternative techniques for tracheal intubation
    • Authors: Karen McCluskey; Miriam Stephens
      Abstract: Publication date: Available online 6 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Karen McCluskey, Miriam Stephens
      Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficult situations. Awake fibreoptic intubation (AFOI) remains the ‘gold standard’ method for securing the airway in an anticipated difficult intubation. Advances in optical technology over recent years have lead to the development of several rigid indirect devices, which improve glottic visualization by enabling the operator to ‘see around the corner’. With improved views at laryngoscopy these videolaryngoscopes are emerging as important tools in airway management and useful teaching and training aids.

      PubDate: 2017-03-11T16:13:30Z
      DOI: 10.1016/j.mpaic.2017.01.008
       
  • Adverse drug reactions
    • Authors: Matthew Charlton; Jonathan Thompson
      Abstract: Publication date: Available online 6 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Matthew Charlton, Jonathan Thompson
      Adverse drug reactions (ADRs) are a common and important cause of morbidity and mortality. They occur frequently in patients undergoing anaesthesia or in Intensive Care. ADRs occur by a number of mechanisms, some of which remain unclear, but several risk factors have been identified. It is increasingly recognized that pharmacogenetic factors are important in determining susceptibility to ADRs. Medical practitioners should be aware of their responsibility to report ADRs and know how to report them.

      PubDate: 2017-03-11T16:13:30Z
      DOI: 10.1016/j.mpaic.2017.01.005
       
  • Gas, tubes and flow
    • Authors: Mark A. Henderson; Colin Runcie
      Abstract: Publication date: Available online 3 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Mark A. Henderson, Colin Runcie
      Optimizing the flow of both liquids and gases is crucial to many areas of anaesthetic and critical care practice. In this article, we describe the physical principles which govern the flow of gases and present scenarios from clinical practice to illustrate these concepts. The difference between laminar and turbulent flow is explained along with the factors which determine the nature of the fluid flow. The Venturi Effect, Bernoulli Principle and Coanda Effect are also described with reference to their clinical applications and their relevance to medical devices.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.009
       
  • Airway trauma
    • Authors: Deirdre Conway; Craig S. Urquhart
      Abstract: Publication date: Available online 3 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Deirdre Conway, Craig S. Urquhart
      Airway trauma should be considered according to location and mechanism of injury. Mechanism of airway trauma can be broadly classified as blunt, penetrating and thermal/chemical. Airway strategy and planning is key to safe management. These patients may be challenging to manage and complicated by polytrauma. It is essential to remember that the patient's airway may deteriorate rapidly and contingency planning for this should be in place. A structured approach to the patient is essential and delayed diagnosis may worsen outcome.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.011
       
  • Percutaneous tracheostomy and cricothyrotomy techniques
    • Authors: Nicola Doody; Neil Smart
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Nicola Doody, Neil Smart
      Percutaneous tracheostomy is an increasingly common procedure performed in the intensive care unit setting. This review discusses the evidence behind its use, provides detailed description of the techniques, and considers the principles of post-tracheostomy care based on recent national audit. It also outlines the most recent recommendations for emergency front of neck access, an essential skill for all anaesthetists and other emergency specialists.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.012
       
  • Transtracheal jet ventilation
    • Authors: Shubhranshu Gupta; Rajib Ahmed
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Shubhranshu Gupta, Rajib Ahmed
      Transtracheal jet ventilation (TTJV) is a method of lung ventilation via a narrow-bore catheter placed percutaneously into the trachea, bypassing the upper airway and glottis. A pressurized jet of oxygen that entrains air is delivered to the lungs. This technique can be utilized in both elective and emergency situations. It is no longer recommended by the Difficult Airway Society (DAS) in the ‘Can't Intubate, Can't Oxygenate’ (CICO) situation, as a surgical technique is now recommended in this scenario (unless the practitioner is familiar with TTJV). In the non-CICO emergency situation, TTJV may be utilized to preoxygenate the patient and allow time to secure a definitive airway. Humidified high-flow nasal oxygenation is a more recently described technique that may allow preoxygenation and time for a transtracheal catheter to be placed, and even replace the need for TTJV. However, a jet ventilator should be immediately available in the event of failure of the nasal high-flow system. This article will examine the indications for TTJV and physiology behind its mechanism of action. We will also describe the equipment required, technique and potential complications.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.003
       
  • Histamine and antihistamines
    • Authors: Amr M. Mahdy; Nigel R. Webster
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Amr M. Mahdy, Nigel R. Webster
      Histamine is one of the most extensively studied biological amines in medicine. It stimulates smooth muscle contraction and gastric acid secretion, increases vascular permeability, functions as a neurotransmitter, and plays various roles in immunomodulation, allergy, inflammation, haematopoiesis and cell proliferation. Histamine exerts its effects through four receptors, designated H1–H4. H1 and H2 receptors are widely distributed, H3 receptors are mainly presynaptic, and H4 receptors are mainly haematopoietic. H1 antihistamines are classified as first- and second-generation compounds. First-generation compounds lack specificity and cross the blood–brain barrier causing sedation. Second-generation compounds are less sedating and highly specific. H1 antihistamines have well-documented anti-allergic and anti-inflammatory effects and are well established in the treatment of a variety of allergic disorders. First-generation antihistamines are also used in the treatment of vestibular disorders and can be used as sedatives, sleeping aids and anti-emetics. H2 antihistamines are widely used in the treatment of gastric acid-related disorders; however, proton pump inhibitors are becoming the drugs of first choice in some of these disorders. H3 antihistamines are expected to be of potential value in the treatment of some cognitive disorder. H4 antihistamines could be of potential therapeutic benefit in the management of various immune and inflammatory disorders.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.007
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.02.001
       
  • Ear, nose and throat emergencies
    • Authors: Dmitrijs Sokolovs; Ker Wei Tan
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Dmitrijs Sokolovs, Ker Wei Tan
      Airway emergencies comprise a diverse group of conditions, which affect upper and lower airways, and have potential for rapid deterioration and lethal outcome unless managed promptly and efficiently. The latter depends on individual skills and effective interaction between anaesthetists, ENT surgeons and other members of the team.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.004
       
  • Special senses
    • Authors: Chris J.D. Pomfrett
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Chris J.D. Pomfrett
      Special senses are those regulated by the cranial nerves, and are of general interest for practitioners of anaesthesia and intensive care. This article gives a brief description of the neural mechanisms and pathways responsible for vision, hearing, smell, balance and taste.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.002
       
  • Obstructive sleep apnoea and anaesthesia
    • Authors: Kim Flatman; Diana Raj
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Kim Flatman, Diana Raj
      Obstructive sleep apnoea is the most prevalent sleep disorder, affecting up to 5% of the population. It can have profound effects on patients perioperatively and can have a considerable impact on morbidity and mortality. Patients require thorough preoperative assessment including the taking of a detailed history, the use of scoring systems to assess severity (such as the STOP-Bang questionnaire) and physical examination with particular attention to the airway. Elective surgery patients who are deemed to be high risk for OSA should be referred for polysomnography with implementation of CPAP prior to surgery if indicated. Those deemed low risk may be suitable for day surgery. Intraoperative anaesthesia management may include regional anaesthesia, local anaesthetic infiltration or general anaesthesia, depending on the symptoms and the nature of surgery. Particular attention should be paid to a potential difficult airway, the use of short acting agents with a rapid wake up and avoidance of sedatives and opioids. OSA patients have an increased risk of cardiovascular and respiratory postoperative complications. Postoperative management should be based on the severity of OSA, the occurrence of adverse respiratory events in the recovery unit and the need for opioid analgesia.

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.010
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      Abstract: Publication date: Available online 2 February 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-02-08T10:41:56Z
      DOI: 10.1016/j.mpaic.2017.01.001
       
  • Shock: causes, initial assessment and investigations
    • Authors: Paul Teirney; Bilal Ahmed; Alistair Nichol
      Abstract: Publication date: Available online 29 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Paul Teirney, Bilal Ahmed, Alistair Nichol
      Shock may result from a number of distinct disease processes and it is commonly associated with trauma, infection and cardiovascular dysfunction. Shock results in significant morbidity and mortality and is a leading cause of death in hospital patients. In order to improve patient outcomes it is important to recognize shock early, then assess and treat the shocked patient in a systematic way. While the cause of the shocked state is sometimes obvious, in more difficult situations the use of the clinical classification of shock into cardiogenic, obstructive, hypovolaemic or distributive shock can help the clinician to discover the underlying cause of the shock. However, it is important to note that while this is a framework in practice there if often considerable overlap between these different types of shock in clinical practice. After identification of patients in shock, immediate life-saving resuscitation with directed therapy to prevent further deterioration, worsening organ failure and to improve outcome is vital. An ABCDE approach can be a useful systematic way for initial assessment and resuscitation. Basic monitoring should be instituted as soon as possible and in severe or unresponsive shock this should be escalated to invasive monitoring. Immediate generic laboratory, microbiological and radiological tests should be carried out as soon as possible and should include a blood lactate level. Further targeted tests should then be tailored to the history, clinical findings and presumed aetiology of the shocked state. These targeted investigations should help to pin point the specific cause of the shock and guide definitive management.

      PubDate: 2017-02-08T10:41:56Z
      DOI: 10.1016/j.mpaic.2016.12.003
       
  • The management of pulmonary embolism
    • Authors: Jane E. Lewis; David V. Pilcher
      Abstract: Publication date: Available online 19 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Jane E. Lewis, David V. Pilcher
      Pulmonary embolism (PE) is a significant cause of hospitalization, morbidity and mortality and frequently triggers referral to critical care services. Critically ill patients are also at increased risk of developing venous thrombo-embolism (VTE) and acute PE. Critical care clinicians should be confident in their approach to the patient with suspected and diagnosed PE. Furthermore, the co-morbid conditions in this patient group may present additional challenges both in diagnosis (e.g. safe access to radiology) and management (e.g. absolute and relative contraindications to anticoagulation/thrombolysis in critically ill patients). This brief review summarizes the contemporary evidence base regarding both diagnosis and treatment strategies and draws upon this to suggest a simple algorithm for investigation, risk stratification and management, particularly tailored to patients within a critical care setting.

      PubDate: 2017-02-08T10:41:56Z
      DOI: 10.1016/j.mpaic.2016.12.001
       
  • Ischaemic cardiogenic shock
    • Authors: Arne Diehl
      Abstract: Publication date: Available online 19 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Arne Diehl
      Recognition of cardiogenic shock in the setting of myocardial ischaemia has important prognostic and therapeutic implications. Mortality remains high in the order of 50%, despite introduction of urgent revascularization. Resuscitative efforts should focus to avoid multi-organ dysfunction with further spiralling instability that commonly is irreversible. To interrupt these processes, timely recognition and restoration of adequate perfusion is mandatory. The therapeutic means to achieve this beyond early revascularization have been widely debated, in particular the extent of pharmacological support and the timing of mechanical support form key components of modern intensive care treatment. Further research work on optimal support and patient selection for more advanced therapies is required.

      PubDate: 2017-02-08T10:41:56Z
      DOI: 10.1016/j.mpaic.2016.12.002
       
  • Intermediary metabolism
    • Authors: Iain Campbell
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Iain Campbell
      Carbohydrate and fat form the immediate and long-term energy stores of the body. Protein constitutes the active (functional) cell mass and is also an energy source but, normally, a relatively minor one. All three macronutrients are interrelated. Proteins are synthesized from amino acids derived from ingested protein. Glucose and fat provide energy via adenosine triphosphate. The brain and red blood cells can only obtain their energy from glucose. Glucose is oxidized via the glycolytic and the tricarboxylic acid (Krebs) cycle pathways. Fatty acids are metabolized by the process of β-oxidation, whereby two carbon fragments are cleaved from the fatty acid chain and enter the Krebs cycle. Amino acids are deaminated to keto acids and the nitrogen moiety excreted in the urine mostly as urea. The keto acids enter the metabolic pathways at various points, mostly in the Krebs cycle. Glucose can be synthesized from lactate, glycerol and amino acids (gluconeogenesis), but not from fatty acids.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.017
       
  • Anaesthetic records
    • Authors: Phillip Dickinson; James Berrington
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Phillip Dickinson, James Berrington
      Anaesthetic records continue to be an essential component of modern anaesthetic practice. This article explores their multiple purposes and the guidelines for their content. It also discusses the practical means of documenting the events that take place during an anaesthetic episode and the benefits and drawbacks of automated electronic records.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.015
       
  • Protective mechanisms of the body
    • Authors: Iain Campbell
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Iain Campbell
      The surface of the body and the openings of the various body cavities (respiratory tract, gastrointestinal tract, genitourinary tract) are at potential risk from injury and from pathogenic bacteria. The surface of the skin is acidic and inhibits the growth of organisms. Non-pathogenic bacteria (commensals) compete with pathogens for space and nutrients and so inhibit their growth. The openings to the various body cavities are lined with mucous membrane which traps bacteria and other particles. Skin is also shed and mucous is expectorated, but both types of surface produce chemicals which are bactericidal. A second layer of defence is the lymphatic system situated below the body surfaces which drains via regional lymph nodes to the subclavian veins.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.013
       
  • Local anaesthetic agents
    • Authors: Malachy O. Columb; David Cegielski; Daniel Haley
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Malachy O. Columb, David Cegielski, Daniel Haley
      Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pK a and the ambient pH. Local anaesthetic agents, being weak bases, are bound in the plasma to α1-acid glycoproteins, influencing duration of action. Esters undergo hydrolysis by esterases in the plasma. Amides are subject to phase I and II hepatic cytochrome P450 metabolism. The development of the S-enantiomers, levobupivacaine and ropivacaine, has not been without some controversy with regards to therapeutic benefits when assessed by clinical potency models such as the minimum local analgesic concentration (MLAC). Drugs derived from biological toxins that target and bind to the sodium ionophore are gaining acceptance for use as analgesics in chronic pain.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.012
       
  • Databases
    • Authors: James Berrington
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): James Berrington
      A database is a structured collection of records or data that is stored in a computer so that it can be consulted by a program to answer queries. Records retrieved through queries become information that can be used to make decisions. A database consists of one or more tables containing records of values for fields that pertain to the attributes of the object being represented by the table. Relational databases contain multiple tables that are linked by means of key fields. A database management system is the computer program that manages the database and queries the data to produce reports of information. Examples of simple databases and how they are produced are described in this article.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.016
       
  • Macronutrients, minerals, vitamins and energy
    • Authors: Iain Campbell
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Iain Campbell
      Carbohydrates have the general formula C n (H2O) n . Monosaccharides have between three and six carbon atoms and exist as chains or ring structures. As rings, they link with other monosaccharide rings. The major carbohydrate in humans is glucose, which is stored as glycogen: branching chains of glucose molecules. Fat (triglyceride), which makes up adipose tissue, consists of three fatty acids bonded to glycerol, but other lipids include phospholipids and steroids. Proteins are composed of chains of amino acids linked by amide bonds folded on each other to form protein structures. Vitamins and minerals are obtained from the diet and are required in varying quantities for a variety of metabolic processes. Energy is derived from the oxidation of carbohydrate, fat and protein. Energy expenditure and substrate oxidation can be calculated from oxygen consumption, carbon dioxide production and urinary nitrogen excretion.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.014
       
  • Maintenance of anaesthesia
    • Authors: Thomas E.F. Walton; James Palmer
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Thomas E.F. Walton, James Palmer
      The maintenance phase of general anaesthesia begins immediately following induction of, and ends immediately prior to emergence from, a state of intended unrousable unconsciousness. Maintenance of anaesthesia requires the application of a wide range of knowledge and skills, demanding a solid grounding in basic science, practical abilities and team management. These factors are considered in this article.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.010
       
  • Electrolyte disorders in the critically ill
    • Authors: Sing Chee Tan; Ross Freebairn
      Abstract: Publication date: Available online 18 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sing Chee Tan, Ross Freebairn
      Electrolyte disorders are extremely common in the critically ill patient. Competent analysis and management of these is essential in providing quality intensive care. This article provides a review of and guide to the aetiology, analysis, and management of major electrolytes disorders in the critically ill.

      PubDate: 2017-01-19T04:54:37Z
      DOI: 10.1016/j.mpaic.2016.11.011
       
  • Principles of anaesthesia for term neonates
    • Authors: Kylie McGregor
      Abstract: Publication date: Available online 9 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Kylie McGregor
      Anaesthesia for term neonates is associated with increased perioperative morbidity and mortality and as a result should be reserved for specialized paediatric centres. Neonatal systems are immature and are undergoing rapid growth and development. Neonates are uniquely different in how they respond to surgery, drugs and fluids and this response varies across the neonatal period. Many of the physiological differences in neonates are a reflection of their high metabolic rate, increase in oxygen demand and maturing organ systems. Due to the difficulties in studying this age group, a lot is still unknown about neonatal physiology and pharmacology.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.002
       
  • The treatment of hypertension in pregnancy
    • Authors: Umbareen Siddiqi; Felicity Plaat
      Abstract: Publication date: Available online 9 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Umbareen Siddiqi, Felicity Plaat
      Maternal deaths from complications of pregnancy; so-called ‘direct deaths’, including hypertensive disorders, are now less than from indirect causes, (medical conditions that may be exacerbated by pregnancy). The direct death rate in the UK has fallen significantly over the past 5 years. The death rate from hypertensive disorders is at its lowest ever: 0.25/100 × 103 maternities [95%CI 0.09–0.55]. In other words there is one death from hypertensive disorders for every 400,000 maternities. Having been one of the leading direct causes of maternal mortality, it now lags behind thromboembolic disease, haemorrhage and amniotic fluid embolism. This improvement is likely to reflect careful management not a fall in incidence as hypertensive disorders remain one of the commonest complications of pregnancy. The precise trigger for pre-eclampsia has yet to be elucidated but the pathophysiology involves abnormal placentation and an exaggerated inflammatory response causing a multisystem disorder. Raised or rising blood pressure in a pregnant woman should alert the clinician to look for the development of pre-eclampsia. Diagnosis and treatment of hypertensive disorders in pregnancy is vital they are associated with both a worse maternal and fetal outcome. Current recommendations suggest that all pregnant women with a systolic blood pressure greater than 160 mmHg should have immediate antihypertensive therapy and treatment should be initiated at lower pressures if the overall clinical picture suggests rapid deterioration. Regional anaesthesia is recommended for both labour analgesia and operative delivery. In the presence of compromised placental function and intrauterine growth restriction, regional blockade has the beneficial effect of improving placental blood flow.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.005
       
  • Adaptation for life after birth: a review of neonatal physiology
    • Authors: Daniel Riviere; Christopher J.D. McKinlay; Frank H. Bloomfield
      Abstract: Publication date: Available online 5 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Daniel Riviere, Christopher J.D. McKinlay, Frank H. Bloomfield
      Life as a fetus is very different from life after birth. The neonatal period (first 28 days of life or 44 weeks postconception age) is a period of dramatic and rapid physiological changes. These vary from the immediate adaptations to extrauterine life to a consequent gradual maturation of organ function. Questions still exist around this transition concerning the optimal oxygen concentration during resuscitation, methods of respiratory support, facilitation of cardiovascular changes, identification of at-risk infants for problems such as hypoglycaemia and hypothermia, and the role of therapeutic hypothermia. This article combines well established and contemporary information to summarize a systems-based approach to traditional neonatal physiology.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.008
       
  • Acute pain management in the neonate
    • Authors: Glyn Williams
      Abstract: Publication date: Available online 3 January 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Glyn Williams
      Acute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be not directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a multi-modal approach to treatment using both pharmacological and non-pharmacological interventions.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.006
       
  • Resuscitation of the newborn
    • Authors: Lindsay F.J. Mildenhall
      Abstract: Publication date: Available online 30 December 2016
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Lindsay F.J. Mildenhall
      A newborn baby has innate reserves to withstand the physiological stress of labour and delivery. These reserves can become depleted and for a small proportion of newborns, assistance is required to aid transition from placental to extra-uterine pulmonary respiration. The compromised newborn arrest is a respiratory arrest and for the vast majority of those needing assistance with the transition, simple airway support manoeuvres will suffice. This article outlines the cascade of evidence-based interventions that include and follow on from airway support in those newborns requiring ongoing assistance. These comments are based around the International Liaison Committee of Resuscitation (ILCOR) 2010 and 2015 Consensus on Science statements and subsequent guideline reviews.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.004
       
  • Neonatal pharmacology
    • Authors: Brian J. Anderson
      Abstract: Publication date: Available online 28 December 2016
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Brian J. Anderson
      Neonatal anaesthesia dosing needs to be based on physiological characteristics of the newborn, pharmacokinetic knowledge, pharmacodynamic considerations and the adverse effects profile. Disease processes and treatments in this group are distinct from adults. Immaturity of enzyme, anatomical and physiological systems cause extensive variability of drug disposition and drug response in neonates. This is further compounded by pharmacogenomic influences. Postmenstrual age is a reasonable measure for maturation of clearance pathways. The neonatal response to drugs is altered and monitoring of effect that guides adult drug use is limited. While neuromuscular monitoring is robust, few other clinically applicable tools are available to provide pharmacodynamic effect feedback. Tools that assess depth of anaesthesia, sedation and pain in neonates have potential to improve effectiveness and safety.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.007
       
  • Anaesthesia for specialist surgery in infancy
    • Authors: Amanda Dalton; Graham Knottenbelt
      Abstract: Publication date: Available online 26 December 2016
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Amanda Dalton, Graham Knottenbelt
      Specialist surgery in infancy provides unique and significant challenges for paediatric anaesthetists. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos (omphalocele), gastroschisis and congenital lobar emphysema) require a sound understanding of the relevant pathology and the particular issues that may be encountered in order to safely anaesthetise these infants. It is important to maintain a high attention to detail and to strive for excellent communication between all members of the perioperative team. In the last decade there has been a rise in the number of procedures in infancy being performed with a minimally invasive technique and this has a wide range of implications for anaesthesia.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.003
       
  • Special considerations in the premature and ex-premature infant
    • Authors: Geoff Frawley
      Abstract: Publication date: Available online 26 December 2016
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Geoff Frawley
      Ex-premature infants and children are a heterogenous population, ranging from healthy children born at 36 weeks' gestation to formerly extremely premature children with significant medical issues that affect anaesthetic care. Preterm birth is associated with perinatal mortality, neurological disability (including cerebral palsy), severe morbidity in the first weeks of life, prolonged hospital stay after birth, readmission to hospital in the first year of life and increased risk of chronic lung disease. Around 3% of newborns have a major congenital physical anomaly with 60% of congenital anomalies affecting the brain or heart and around 1% having multiple anomalies. Individual congenital conditions requiring surgical intervention in the neonatal period are rare. Gastroschisis is one of the most common abnormalities and has an incidence of around 1 in 2500 live births. Outside of the neonatal period, the most common surgical procedures performed in ex-premature infants are inguinal hernia repair and ophthalmologic procedures for underlying retinopathy of prematurity. After even minor surgical procedures, ex-premature infants are at higher risk for postoperative complications than infants born at term.

      PubDate: 2017-01-12T04:45:43Z
      DOI: 10.1016/j.mpaic.2016.11.001
       
 
 
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