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Publisher: Elsevier   (Total: 3044 journals)

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Showing 1 - 200 of 3044 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 22, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 21, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 84, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 24, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, 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: 342, 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   (Followers: 1)
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: 215, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (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: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, 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: 3)
Acute Pain     Full-text available via subscription   (Followers: 13)
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: 21)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 135, 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: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, 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: 25, 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: 22, 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: 25, 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: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 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 Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 5)
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: 41, 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: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 48, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 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: 21, 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 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: 35, 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: 6)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 15, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
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: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 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: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 61)
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: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 350, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, 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: 317, 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: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 411, 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: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 39, 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: 54, 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: 5, 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: 8)
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: 8, 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: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 8, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 47, 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: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 39, 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: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, 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: 192, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 56, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 4)
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: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, 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: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
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: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 167, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 160, 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   (Followers: 1, 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)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover Anaesthesia & Intensive Care Medicine
  [SJR: 0.124]   [H-I: 9]   [55 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1472-0299
   Published by Elsevier Homepage  [3044 journals]
  • Anaesthetic priorities in pre-hospital trauma care
    • Authors: Sarah Fadden; Kate Prior
      Pages: 375 - 379
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Sarah Fadden, Kate Prior
      Trauma is a significant cause of morbidity and mortality in the UK. Developments in the delivery of pre-hospital trauma care and advances in techniques for managing critically injured patients on scene, partly due to military medical experiences in recent conflicts, have encouraged greater scrutiny of the performance of these services. In addition to the unique environmental and logistical challenges posed by pre-hospital care, the injury and physiology patterns typically associated with trauma patients necessitate a specific approach to their assessment and treatment, whereby control of Catastrophic haemorrhage is prioritized before management of Airway, Breathing and Circulation issues (<C>ABC). The time-critical casualty needs to be recognized, and immediate life- or limb-threatening complications addressed promptly, with expedited evacuation to definitive hospital care. In 2011 the General Medical Council (GMC) approved Pre-hospital Emergency Medicine (PHEM) as a subspecialty of Emergency Medicine and Anaesthetics, thereby highlighting it as an area of medical expertise which requires training of its practitioners, as well as demonstration of competent, evidence-based, and meticulously audited practice.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.004
       
  • Pain priorities in pre-hospital care
    • Authors: Susan Hanson; Ashley Hanson; Dominic Aldington
      Pages: 380 - 382
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Susan Hanson, Ashley Hanson, Dominic Aldington
      Pain management in the pre-hospital environment is a priority following life- and limb-saving manoeuvres. Pain should be assessed, documented and managed according to a multimodal model. Even in the context of environmental challenges and limited resources, pharmacological, physical and psychological interventions can be used to provide effective analgesia and relieve suffering prior to and during transfer to hospital.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.001
       
  • Management of major trauma
    • Authors: Jonathan Pearson; Jeremy Henning; Katherine Woods
      Pages: 383 - 385
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Jonathan Pearson, Jeremy Henning, Katherine Woods
      Trauma remains one of the leading causes of mortality and morbidity in the UK, is the primary cause of mortality in the first four decades of life and has a significant impact on the economy of the nation. In recent years the structure of trauma care has undergone significant restructuring. This article will review the reports that led to these changes, discuss the changes that have occurred and describe some of the anaesthetic management of this important group of patients.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.011
       
  • Management of shock in trauma
    • Authors: Matthew Boyd; Damian D. Keene
      Pages: 386 - 389
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Matthew Boyd, Damian D. Keene
      Shock is defined as the failure of the circulatory system to provide the organ perfusion and tissue oxygenation required to meet cellular metabolic demands. Traumatic shock is most commonly associated with haemorrhage, although non-haemorrhagic shock can be found in trauma in the form of cardiogenic or neurogenic shock. Over the last decade evidence has demonstrated that trauma patients have an acute traumatic coagulopathy (ATC) caused by the injury process itself. This has been fundamental to the development of the current approach to management of traumatic shock, known as damage control resuscitation (DCR). DCR encompasses three key resuscitative strategies, permissive hypotension, haemostatic resuscitation (the use of blood products as primary resuscitative fluids) and damage control surgery. The implementation of DCR alongside the creation of trauma networks has been revolutionary in the management of the shocked trauma patient. Current focus is on evolving and refining these strategies including identifying the subsets of patients at greatest risk as early as practicable following injury.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.002
       
  • Chest trauma
    • Authors: Yogasundaram Arunan; Bevan Roodenburg
      Pages: 390 - 394
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Yogasundaram Arunan, Bevan Roodenburg
      This article summarizes major life-threatening injuries in thoracic trauma. Timing, clinical features, necessary investigations and interventions are described within the clinical approach of primary and secondary surveys. Emphasis is on immediate resuscitation with some discussion on further management. Injuries included are tension pneumothorax, open pneumothorax, massive haemothorax, pericardial tamponade, aortic injuries, cardiac injuries, lung contusion, flail chest, diaphragmatic injury, airway injury and oesophageal rupture.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.008
       
  • Critical care management of severe burns and inhalational injury
    • Authors: Andrew Clarey; Dominic Trainor
      Pages: 395 - 400
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Andrew Clarey, Dominic Trainor
      Anaesthetists and critical care physicians involved in emergency care provision, must be equipped with the knowledge and skills to accurately assess and initiate treatment in patients with severe burns. This summary aims to review airway management and fluid resuscitation in addition to sedation and analgesic choices. Some of the dogma involved in current aspects of modern burns care will also be questioned.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.009
       
  • Drowning and immersion injury
    • Authors: Alison B Main; Andrew J Hooper
      Pages: 401 - 403
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Alison B Main, Andrew J Hooper
      Drowning is a frequent cause of accidental deaths and injuries, resulting in a significant but preventable global health problem. It is characterized by respiratory impairment due to submersion of the airway, or immersion of the body including the airway, leading to global hypoxic injury. Risk factors for drowning include inadequate supervision of children, recreational or occupational access to water, risk-taking behaviour and underlying medical conditions. Management priorities include rescue and basic life support, with an emphasis on rescue breaths and reversal of hypoxia. Compression-only cardiopulmonary resuscitation is not recommended in drowning victims. Supportive critical care is directed towards optimizing oxygenation and circulation, and preventing complications. Temperature control is important, as hypothermia complicates drowning and may limit the efficacy of resuscitative attempts when severe. Survival rates after cardiac arrest due to drowning are poor, and patients who are unconscious on admission to hospital have a guarded prognosis. Consequently public health initiatives to prevent drowning are important.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.006
       
  • Spinal cord injury
    • Authors: Bob Winter; Hina Pattani; Emma Temple
      Pages: 404 - 409
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Bob Winter, Hina Pattani, Emma Temple
      With an annual incidence of 13 per million, around 40,000 people in the UK live with spinal cord injury (SCI). The extent of morbidity and mortality and thus quality of life, is highly dependent on meticulous management from the first point of contact with medical services. Treatment is focused on reducing the risk of further cord injury and prevention of secondary (penumbral) damage through avoidable complications. As key members of trauma, theatre, intensive care and pain teams, anaesthetists and intensivists play a crucial role in influencing patient outcome in both the acute setting and in managing patients with chronic SCI presenting for emergency or elective surgical intervention.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.010
       
  • Anaesthesia outside the theatre environment
    • Authors: Jonathan D. Minton; David J. Daly
      Pages: 410 - 413
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Jonathan D. Minton, David J. Daly
      Remote anaesthesia is the provision of anaesthesia and sedation outside the theatre environment. The diverse range of locations, procedures and patient groups can provide a challenge to the anaesthesia team. Anaesthetists must maintain the same high standards as in the operating room, which requires appropriate facilities and staff, as well as suitable pre and post anaesthesia care.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.003
       
  • The metabolic and endocrine response to trauma
    • Authors: Amy Krepska; Jennifer Hastings; Owen Roodenburg
      Pages: 414 - 417
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Amy Krepska, Jennifer Hastings, Owen Roodenburg
      Metabolic and endocrine pathways are central to the body's compensatory response to trauma. They drive mobilization of energy substrates, volume conservation and haemostasis via activation of the hypothalamic pituitary adrenal axis, the sympathetic nervous system and an inflammatory response. As clinicians, we can intervene in these pathways, however optimal management of anaesthesia, fluids, transfusion, nutrition and the use of steroids remains controversial and to be determined.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.007
       
  • Pharmacology of plasma expanders
    • Authors: Robert McCahon; Jonathan Hardman
      Pages: 418 - 420
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Robert McCahon, Jonathan Hardman
      Plasma expanders are used to restore the circulating volume of a hypovolaemic patient. Typically, colloids are used to expand the plasma volume, although combinations of hypertonic crystalloid and colloid have recently been used. The currently available colloids vary in their physicochemical, pharmacodynamics and pharmacokinetic properties. In particular, they differ in molecular weight, which partly determines their duration of action, and in their ability to expand the plasma volume. Dextran, hydroxyethyl starch and hypertonic colloid solutions improve oxygen flux within the microcirculation. Despite their benefits, the use of dextran and high-molecular-weight starches is limited by their negative impact on coagulation. In addition, these macro-molecules may also induce acute renal failure in susceptible patients. Current research focuses on the development of artificial oxygen carriers as plasma expanders. These substances, which include modified stromal-free haemoglobin and perfluorocarbon emulsions, are undergoing clinical trials.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.05.005
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      First page: 161
      Abstract: Publication date: August 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 8
      Author(s): Vijayanand Nadella


      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.01.001
       
  • Self-assessment
    • Authors: Viyayanand Nadella
      Abstract: Publication date: Available online 9 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Viyayanand Nadella


      PubDate: 2017-09-11T13:44:17Z
      DOI: 10.1016/j.mpaic.2017.08.001
       
  • Pharmacological control of blood sugar
    • Authors: Sudesna Chatterjee; Melanie J. Davies; Giridhar Tarigopula
      Abstract: Publication date: Available online 6 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sudesna Chatterjee, Melanie J. Davies, Giridhar Tarigopula
      Diabetes is a chronic and progressive metabolic disorder characterized by hyperglycaemia. The two main types of diabetes are type 1 diabetes (T1DM) where there is complete lack of insulin and type 2 diabetes (T2DM) which may be due to a combination of insulin resistance and relative insulin deficiency due to impaired β-cell function. Good control of blood glucose near physiological limits is vital to reduce long-term microvascular and macrovascular complications of diabetes. Insulin replacement is a life-saving measure in individuals with T1DM whereas the mainstay of therapy in T2DM includes oral agents, non-insulin injectables (incretin mimetics) and insulin. In T2DM, the incretin mimetics and sodium glucose co-transporter 2 inhibitors have revolutionized recent treatment options by reducing blood glucose, promoting weight loss and improving β-cell function with improved cardiovascular outcomes associated with some of these agents. Despite the availability of several drugs to treat this chronic debilitating condition, the management of hyperglycaemia remains challenging. The role of diet, lifestyle changes and patient education is of paramount importance and should be pursued aggressively. This review will look at drugs currently used to optimize blood glucose control and briefly discuss the role of newer therapeutic agents.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.017
       
  • Starvation, exercise and the stress response
    • Authors: Christopher Naisbitt; Susie Davies
      Abstract: Publication date: Available online 18 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Christopher Naisbitt, Susie Davies
      Starvation, exercise and the stress response have a physiological impact on the body. Many patients are malnourished, have impaired exercise tolerance or undergo the stress response. We describe how the body adapts to decreased nutrient supply, increased energy demands and to stress.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.020
       
  • Thyroid disease and thyroid surgery
    • Authors: Zoe Parry; Ross Macnab
      Abstract: Publication date: Available online 18 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Zoe Parry, Ross Macnab
      Thyroid disease remains very common. Knowledge of the implications of these diseases is essential for all anaesthetists as these patients are frequently encountered and may be at risk of complications at any stage, preoperatively, intraoperatively or postoperatively. This article focuses on disorders of thyroid function and their management, thyroid malignancy, surgery of the thyroid gland and the perioperative anaesthetic management of patients undergoing thyroidectomy.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.015
       
  • Thyroid, parathyroid hormones and calcium homeostasis
    • Authors: Rebecca Summers; Ross Macnab
      Abstract: Publication date: Available online 18 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Rebecca Summers, Ross Macnab
      The thyroid gland secretes thyroxine (T4) and triiodothyronine (T3) in response to thyroid-stimulating hormone release from the anterior pituitary gland. Iodine is essential for the synthesis of thyroid hormones. T4 and T3 increase the basal metabolic rate, heat production, and help to maintain normal growth and development. Serum calcium levels are under very tight control. The majority of calcium is found in bones. Calcium and phosphate levels are maintained by four hormones – parathyroid hormone (PTH), calcitonin, vitamin D and fibroblast growth factor 23. PTH is produced by the parathyroid glands and its secretion is determined by serum calcium levels.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.023
       
  • Recognition and management of phaeochromocytoma and paraganglioma
    • Authors: Henry Wang; Chandran Jepegnanam
      Abstract: Publication date: Available online 17 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Henry Wang, Chandran Jepegnanam
      Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.022
       
  • Anaesthetic management of diabetes
    • Authors: Michael McGinlay; Swamy Mruthunjaya
      Abstract: Publication date: Available online 16 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Michael McGinlay, Swamy Mruthunjaya
      Diabetes is a complex, chronic metabolic disorder affecting approximately 8.5% of the adult population with the number of people living with diabetes worldwide having almost quadrupled since 1980. This increase has largely been attributed to global urbanization and lifestyle changes. Diabetes affects 10–15% of the surgical population. These patients are now frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with diabetic patients demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. As the management of diabetes becomes more complex, it is vital that the anaesthetist, as a member of the multidisciplinary team, remains up-to-date and plays a key role in patient optimization and perioperative glycaemic control. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. Patients themselves are well experienced in managing their own diabetes and should be involved in doing so whenever possible.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.016
       
  • Clinical aspects of endocrinology: parathyroid and adrenal gland disorders
    • Authors: Ahmad Moetamin; Kailash Bhatia
      Abstract: Publication date: Available online 16 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ahmad Moetamin, Kailash Bhatia
      The parathyroid glands are responsible for calcium homoeostasis, which is necessary for appropriate functioning of the musculoskeletal and nervous systems. Parathyroid adenoma remains the most common indication for surgery. Anaesthetic considerations for parathyroid surgery include good hydration, appropriate positioning, monitoring renal function along with serum electrolytes. The adrenal cortex is mainly responsible for secretion of mineralocorticoids, glucocorticoids, and androgens whereas the medulla consists of pre-ganglionic sympathetic ganglion, which secretes epinephrine, nor-epinephrine and dopamine. Adrenocortical disease results in disturbance of water balance, electrolytes, cardiovascular instability and metabolic disturbances. Correction of water, electrolyte imbalance, blood pressure control with invasive monitoring, appropriate positioning, analgesia with appropriate hormone replacement therapy form the key principles of the anaesthetic management.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.011
       
  • Homeostasis in dynamic self-regulatory physiological systems
    • Authors: Niroshini Nirmalan; Mahesh Nirmalan
      Abstract: Publication date: Available online 16 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Niroshini Nirmalan, Mahesh Nirmalan
      Understanding the general principles of homeostasis and its regulation in health and disease is key to managing patients in intensive care units and operating theatres. In these environments, it is crucial to realize that physiological control is a dynamic process aimed at achieving a balance between two opposing sets of factors. Whereas one set of factors (e.g. the sympathetic nervous system) attempt to increase a physiological variable of interest at any given time, opposing forces acting almost concurrently, (e.g. the parasympathetic nervous system) will result in the reduction in the value of this variable. The human body is a self-adapting system and as a result of its ability to adapt, new physiological ‘steady states’ will be reached and maintained even in diseases. This review will explore some of the concepts and pathways involved in the regulation of homeostasis in the immediate, intermediate and delayed time scales following an initial perturbation, emphasizing the dynamic nature of this regulation.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.018
       
  • Adrenocortical hormones
    • Authors: Ahmed Osman; Rhys Clayton
      Abstract: Publication date: Available online 16 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ahmed Osman, Rhys Clayton
      Adrenal glands are vital endocrine glands located above the kidneys bilaterally. They play a major rule in sodium and potassium balance. They regulate blood pressure and consequently tissue perfusion both directly, through vasopressor effect of renin–aldosterone–angiotensin system, and indirectly, through the effect on sodium balance. Glucocorticoids play a major rule in regulation of metabolism which affects almost all body tissues. Glucocorticoid release is regulated via the hypothalamic–pituitary–adrenal axis.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.014
       
  • The pancreas
    • Authors: Jennifer Cade; James Hanison
      Abstract: Publication date: Available online 16 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Jennifer E. Cade, James Hanison
      The pancreas plays a vital role in coordinating and regulating digestion and nutrient metabolism, and does so via endocrine and exocrine processes. Insulin and glucagon are produced within the endocrine pancreas to not only achieve glucose homeostasis, but regulate protein and fat metabolism. Enzymes and zymogens are secreted in alkaline pancreatic fluid to aid digestive function. This article looks at how the pancreas achieves such precise synthetic and secretory functions, and reviews the physiology of the secreted hormones and enzymes.

      PubDate: 2017-09-06T13:05:19Z
       
  • Hormonal control of metabolism: regulation of plasma glucose
    • Authors: Niroshini Nirmalan; Mahesh Nirmalan
      Abstract: Publication date: Available online 15 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Niroshini Nirmalan, Mahesh Nirmalan
      Blood glucose concentrations are required to be maintained within a narrow therapeutic range in order to ensure the normal functioning of the body. This is accomplished through a complex, interactive, finely coordinated neuro-endocrine regulatory process. Hormonal control through the opposing actions of insulin and glucagon secreted by the islet cells of the pancreas serve as the primary response mechanism to avert post-prandial hyperglycaemia and fasting hypoglycaemia. In addition to this basic response, a range of endocrine mediators concurrently intervene, to enable the fine modulation of the process through a range of insulin-dependent and insulin-independent processes, which ultimately achieve glycaemic control by influencing tissue glucose uptake, glycolysis, glycogenesis, glycogenolysis and gluconeogenesis. More recent evidence supports a central, predominantly hypothalamic role initiated through nutrient (glucose, fatty acid) and hormonal (insulin, leptin, glucagon-like peptide-1) stimuli that influences glucose regulation by direct or indirect effects on skeletal muscle glucose uptake, islet cell insulin/glucagon secretion and hepatic glucose production.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.019
       
  • Anaesthesia for obesity surgery
    • Authors: Rhys Clayton; Mahmoud Alkholany
      Abstract: Publication date: Available online 14 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Rhys Clayton, Mahmoud Alkholany
      The aim of this article is highlight the anaesthetic management of patients undergoing bariatric (weight loss) surgery. There are different types of commonly performed procedures each of which requires careful perioperative and postoperative management. Those principles can successfully be extrapolated to obese patients undergoing non-obesity surgery.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.013
       
  • Anaesthesia in the obese patient
    • Authors: Graham Nelson; Rhys Clayton
      Abstract: Publication date: Available online 14 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Graham Nelson, Rhys Clayton
      Obesity is an increasing problem and its burden on healthcare resources is well documented. This article gives an overview of the physiological and pharmacological considerations when anaesthetizing the obese patient. It will look at key aspects of assessing obese patients, and planning and delivering a safe anaesthetic to them. Special areas of focus include correct drug dosing, as well as equipment, monitoring and environmental aspects involved in delivering the anaesthetic.

      PubDate: 2017-09-06T13:05:19Z
      DOI: 10.1016/j.mpaic.2017.06.012
       
  • General anaesthesia for dentistry
    • Authors: Susan Hutchinson
      Abstract: Publication date: Available online 2 August 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Susan Hutchinson
      Dental anaesthesia developed down a different pathway from the rest of anaesthesia. Techniques such as nasal mask anaesthesia in the sitting position were specific to dental surgery, which took place largely outside hospital in dental clinics. Now dental anaesthesia is confined to locations within the aegis of a hospital and anaesthetic techniques are similar to those in other surgical specialities. Dental surgery consists of extractions and conservation. Short procedures for the extraction of teeth may still be carried out in children using a nasal mask, but more difficult extractions in adults and children, or conservation procedures are best done with a laryngeal mask or endotracheal tube. Close liaison with the dental surgeon is imperative in the planning of the anaesthetic technique. The downward pressure applied to the mandible during the extraction of teeth may cause reduction in airway patency unless intubated, and the anaesthetist may need to support the jaw and head in order to provide counter-pressure, also preventing excessive movement of the neck. Patients needing general anaesthesia include children, those with allergy to local anaesthetics, and adults with special needs, as well as those adults who are likely to need surgical extractions with removal of alveolar bone. During the recovery phase, the airway has to be watched carefully as the potential for obstruction is increased due to stimulation and soiling of the larynx with bleeding. Paracetamol and non-steroidal analgesics are the mainstay of analgesia in combination with local anaesthetic infiltration and specific dental blocks. In addition, stronger analgesics such as tramadol may be required in adults who are having multiple extractions. It should be an aim to provide all dental surgery in a day case setting, and careful choice of the technique should make this possible for all but those with unstable cardiorespiratory disease.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.007
       
  • Anaesthesia for maxillofacial surgery
    • Authors: Luay Kersan; Urmila Ratnasabapathy
      Abstract: Publication date: Available online 29 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Luay Kersan, Urmila Ratnasabapathy
      Airway management is central to anaesthesia for maxillofacial surgery. Not only is there a shared airway to contend with, difficult airways are frequently encountered. The main pathologies that present for surgery include trauma, infection, cancer and craniofacial deformities. All of these may present an airway challenge in either elective or emergency settings but a similar approach to the airway can be used in all these scenarios. Other surgical procedures include dental extractions, temporomandibular joint (TMJ) arthrocentesis, salivary gland surgery and facial aesthetic surgery. It is vital that clear airway management plans including rescue plans are made at the outset. These must be communicated to the surgical and anaesthetic team in advance. Trauma is excluded as it will be covered in a separate review article.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.010
       
  • Flexible fibreoptic intubation
    • Authors: Vera Sokolova; Dmitrijs Sokolovs
      Abstract: Publication date: Available online 27 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vera Sokolova, Dmitrijs Sokolovs
      Flexible fibreoptic intubation offers options of airway control in awake and asleep patients, in cases with limited or absent mouth opening and complex anatomy. It may be used as a first choice or a rescue technique. Despite its limitations, for example in situations with significant airway blood or secretions, and airway obstruction, it is a valuable core skill for every anaesthetist.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.009
       
  • Self-assessment
    • Authors: Viyayanand Nadella
      Abstract: Publication date: Available online 27 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Viyayanand Nadella


      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.07.001
       
  • Sedation for dental and other procedures
    • Authors: Ruth L. Mawhinney; Alan Hope
      Abstract: Publication date: Available online 27 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ruth L. Mawhinney, Alan Hope
      Conscious sedation is an anaesthetic technique which helps patients tolerate dental and other procedures. Safe sedation requires attention to patient selection, the clinical environment, appropriate intraoperative and recovery monitoring, sedation technique, and postoperative management. Various drugs can be used either singly or in combination. Low doses of short-acting anaesthetic agents allow fine control of sedation and a greater chance of success. Where anaesthetic agents are used, inadvertent overdosage is a risk, and these drugs must be administered by an anaesthetist. Entonox and oral and intravenous benzodiazepines can be safely administered by appropriately trained practitioners. Key definitions include ‘sedation’ and ‘conscious sedation’.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.008
       
  • Dental damage in anaesthesia
    • Authors: Aravind Basavaraju; Kate Slade
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Aravind Basavaraju, Kate Slade
      Dental trauma is a frequently reported complication related to the administration of general anaesthesia and is the most common source of litigation against anaesthetists. General anaesthesia involving direct laryngoscopy, a difficult airway, pre-existing poor dentition and prosthetic dental restoration are major risk factors for dental trauma. Central maxillary incisors are the most frequently damaged teeth. It is good practice to perform a preoperative oral examination, document the findings and communicate the risk of dental trauma to the patient. In the event of dental damage appropriate timely management will minimize dental morbidity.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.002
       
  • Identification of the difficult airway
    • Authors: Sumit Gajree; Kevin J. O'Hare
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sumit Gajree, Kevin J. O'Hare
      Failure to identify a difficult airway can have serious consequences. It is essential that a thorough assessment of a patient's airway is made, including history and a focussed examination. It is known that the reliability of preoperative assessment is disappointing but positive findings will allow for an appropriate airway management plan to be devised in order to minimize airway-related complications. Despite this, situations will still occur where an unexpected difficult airway is encountered.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.004
       
  • Anaesthesia for facial trauma
    • Authors: Cristina Niciu; Val Cunningham; Kevin Fitzpatrick
      Abstract: Publication date: Available online 26 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Cristina Niciu, Val Cunningham, Kevin Fitzpatrick
      Facial trauma is common and can produce both physical and psychological problems for patients. Managing patients in both the emergency setting and elective theatre environment can be extremely challenging, so airway interventions should be carefully planned so the safest and most effective technique can be chosen. This may mean that direct laryngoscopy may not be the safest or most straightforward option and awake fibreoptic intubation, videolaryngoscopy, submental intubation or awake tracheostomy may be a better choice in a given set of circumstances. An understanding of common mechanisms of injury and pathologies and the likely difficulties that will be present are essential. Senior anaesthetic input and effective teamwork are required to provide excellent levels of care for these patients.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.003
       
  • Pharmacokinetic analysis
    • Authors: William J.D. Whiteley; Jonathan G. Hardman
      Abstract: Publication date: Available online 25 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): William J.D. Whiteley, Jonathan G. Hardman
      Pharmacokinetic analysis is an experimentally determined theory of how a drug behaves when in vivo. Volume of distribution, clearance and terminal half-life are defined. Compartmental modelling is introduced and some relevant graphs are described in this article. Applications of this theory in anaesthesia are considered.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.006
       
  • Modes of drug elimination and bioactive metabolites
    • Authors: Shruti Chillistone; Jonathan G. Hardman
      Abstract: Publication date: Available online 25 July 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Shruti Chillistone, Jonathan G. Hardman
      Drug elimination is the removal of active drug from the body. Metabolism takes place largely in the liver and produces water-soluble metabolites which can be excreted in the bile or urine. Metabolism may also produce active or toxic metabolites or a pharmacologically active drug from an inactive prodrug. Most volatile anaesthetics are excreted unchanged via the lungs. Drug elimination can be affected by factors such as first-pass metabolism, genetic variants and various disease processes. Knowledge of these processes will allow better prediction of pharmacokinetics in practice.

      PubDate: 2017-08-08T21:39:16Z
      DOI: 10.1016/j.mpaic.2017.06.005
       
  • Mathematical concepts
    • Authors: Ming Wilson
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ming Wilson
      Some concepts in anaesthesia can be explained by exponentials, logarithms, differentiation and integration. The aim of this article is to discuss these mathematical principles and demonstrate their importance in clinical anaesthesia.

      PubDate: 2017-06-13T19:01:17Z
      DOI: 10.1016/j.mpaic.2017.04.014
       
  • SI units
    • Authors: David Williams
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David Williams
      This article summarizes the history and application of the Système Internationale (SI) of units. Non-SI units in common use in anaesthesia and standard units of digital information are also described.

      PubDate: 2017-06-13T19:01:17Z
       
  • Antidepressants and antipsychotics: anaesthetic implications
    • Authors: Rahat Ghafoor; Faisal Rasool
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Rahat Ghafoor, Faisal Rasool
      According to the World Health Organization about 450 million people suffer from mental and behavioural disorders worldwide, whereas depression has a lifetime prevalence of between 10 and 20%. Antidepressants are broadly divided into four main groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), atypical agents and monoamine oxidase inhibitors (MAOIs). Lithium is also occasionally used as an adjunct to treat refractive depression, but is more commonly used as a mood stabilizer in bipolar affective disorder. Antipsychotics are usually classified as ‘conventional’ antipsychotics or ‘atypical’ agents. The anaesthetist has to incorporate these agents in premedication and should anticipate their interactions with anaesthetic technique.

      PubDate: 2017-06-13T19:01:17Z
      DOI: 10.1016/j.mpaic.2017.04.005
       
  • Basic measurement concepts
    • Authors: Gary Thomas; Elana Owen
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Gary Thomas, Elana Owen
      Precise measurement of physiological parameters during anaesthesia is vital, and enables clinicians to deliver safe and appropriate care to patients. Monitoring devices are essential tools in the clinical environment, and accurate records of the measurements provided by these monitors must be kept. The physical parameter to be measured is known as a measurand. Examples of measurands in clinical practice include temperature, voltage and pressure. In the process of measurement, a measurand should be quantitatively compared with a predefined standard. The fundamental components of a basic measurement system consist of a sensor, signal, display at a human interface and a feedback loop. The signal or surrogate marker of a measurand is often processed before display. It is important that the output of a measurement system accurately reflects the value of the measurand. Challenges presented by measurement systems involve the maintenance of precision and accuracy. The input relative to output of a transducer is ideally linear in nature but is subject to hysteresis and drift making regular calibration essential. Outputs of measuring devices will also depend on their ability to respond to static or dynamic change. The readings obtained from measurement devices are also subject to human error.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.009
       
  • Factors affecting drug absorption and distribution
    • Authors: Shruti Chillistone; Jonathan G. Hardman
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Shruti Chillistone, Jonathan G. Hardman
      The pharmacokinetic properties of a drug comprise the relationship between its absorption, distribution and inactivation. The passage of drugs across cell membranes is a key part of most pharmacokinetic processes. The most important means by which a drug crosses cell membranes is passive diffusion, the rate of which is determined by molecular size, the concentration gradient, lipid solubility, degree of ionization of the drug and protein binding. Pharmacokinetic processes can be summarized and the time course of drug action can be predicted using mathematical compartment models. In a single-compartment model, a drug is evenly distributed throughout the plasma and tissues and eliminated in an exponential manner. However, multicompartment models make allowance for the uptake of drugs from the plasma by different tissues and for different flow rates to these tissues. Drug distribution across the placenta is a special case and considered separately. The placental membrane is a lipid barrier that is less selective than the blood–brain barrier, allowing the passage of lipid-soluble drugs more easily than water-soluble drugs. The distribution and rate of equilibration across the placenta are determined by placental blood flow and the free drug concentration gradient.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.007
       
  • Mechanisms of action of general anaesthetic drugs
    • Authors: David G. Lambert
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David G. Lambert
      Based on the diverse array of anaesthetic structures, a single anaesthetic target site seems unlikely. With the knowledge that anaesthesia likely results from central nervous system depression, it can be hypothesized that anaesthesia results from either enhanced inhibitory transmission or reduced excitatory transmission. Two main targets have been extensively described: GABAA receptors and N-methyl-d-aspartate (NMDA) glutamate receptors. On γ-aminobutyric acid (GABA) binding to GABAA receptors, an influx of Cl− results to produce hyperpolarization. With the exception of ketamine, xenon and nitrous oxide, all anaesthetic agents potentiate GABA-mediated conductance. On binding of the main excitatory transmitter glutamate, NMDA receptors gate an influx of Ca2+ and Na+. Ketamine, xenon and nitrous oxide inhibit this ion movement to depress excitatory transmission.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.008
       
  • Electricity and magnetism
    • Authors: David Williams
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David Williams
      This article introduces essential concepts of electricity and magnetism relevant to anaesthesia. Simple analogies are used to explain current electricity and the action of electronic components in common use. The concept of electric and magnetic fields is introduced with examples of their practical application.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.011
       
  • Mechanisms of drug interactions: pharmacodynamics and pharmacokinetics
    • Authors: Kathryn Corrie; Jonathan G. Hardman
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Kathryn Corrie, Jonathan G. Hardman
      The classification of drug interactions is first considered in this article, with an explanation of the terminology. Emphasis is placed on the importance of the topic in relation to the polypharmacy employed in anaesthesia and critical care. Pharmacodynamic interactions are then discussed. Further classification of these interactions is explained using examples of drugs in everyday use in anaesthesia and critical care medicine. Non-specific pharmacodynamic interactions are considered at some length, being the largest group of drug interactions that occur in anaesthesia. Synergy and summation are extremely relevant to anaesthetic practice and are employed in both induction and maintenance of anaesthesia everyday. The article then explains pharmacokinetic interactions under the headings of absorption, distribution, metabolism and elimination. Again, emphasis is placed on drugs used in current practice to highlight the relevance of each type of interaction to the reader.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.006
       
 
 
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