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Publisher: Elsevier   (Total: 3160 journals)

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Showing 1 - 200 of 3160 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 34, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 96, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 38, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 412, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 258, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 28, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 10, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 154, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 14, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 58, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 23, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 7, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 64)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 399, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 11, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 345, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 456, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 3)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 10)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 51, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 47)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 216, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 42, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 181, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 199, SJR: 1.58, CiteScore: 3)

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Journal Cover
Anaesthesia & Intensive Care Medicine
Journal Prestige (SJR): 0.138
Number of Followers: 62  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1472-0299
Published by Elsevier Homepage  [3160 journals]
  • Pharmacological modulation of cardiac function and blood vessel calibre
    • Abstract: Publication date: Available online 20 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher P. Hebbes Inadequate end organ perfusion and tissue hypoxia is an end point of many disease processes in critical illness. Maintenance of organ perfusion and therefore tissue Oxygenation is critical to patient management in the perioperative period. Global blood flow is determined by a balance of neurohormonal factors, with autoregulation ultimately determining local flow. These factors modulate cardiac output and vasomotor tone. Pharmacological manipulation of both the myocardium and vasculature at the level of the autonomic nervous system (via α or β adrenoceptors), cardiac muscle (e.g. calcium sensitisation via Levosimendan), or locally (e.g. via regional or neuraxial local anaesthetic blockade) is commonly used in anaesthesia to mitigate the effects of critical illness and perioperative stress responses. This enables maintenance of organ perfusion through modulating vascular tone or cardiac output. This article considers the global control of the system through to local and regional regulation of blood flow, and how the system may be manipulated at every level.
       
  • Cardiopulmonary resuscitation and post-resuscitation care
    • Abstract: Publication date: Available online 17 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Michael O'Connor, C Stephanie Cattlin Survival and subsequent good neurological outcome following cardiac arrest depends on prompt diagnosis, good quality cardiopulmonary resuscitation (CPR) with minimal interruptions and rapid defibrillation, if appropriate. In the post resuscitation phase, diagnosis and treatment of the underlying cause for the arrest with avoidance of hypotension, hyperthermia, hyperoxia, hyper/hypoglycaemia and management of seizure activity confers the best chances of a successful outcome. Early prognostication of survivors is difficult and should be done by experts using a variety of proven modalities.
       
  • Central venous cannulation
    • Abstract: Publication date: Available online 14 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Peter B Williamson, C Stephanie Cattlin Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.
       
  • Pain, agitation and delirium in the intensive care unit
    • Abstract: Publication date: Available online 14 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher McGovern, Richard Cowan, Richard Appleton, Barbara Miles Pain, agitation and delirium are common during critical illness and are associated with many adverse consequences. A key aim of critical care is the facilitation of a calm, comfortable patient who can interact with their family and staff. Intensive care unit (ICU) patients frequently have pain from a variety of sources, many of which are not readily appreciated or actively managed. This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will also explore delirium, its risk factors, precipitants and associated morbidity and mortality. This article will discuss how to diagnose delirium and the methods used to prevent and manage it.
       
  • Drugs affecting coagulation
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Balraj Appadu, Katrina Barber For more than half a century, heparin and vitamin K antagonists have defined anticoagulant therapy in both the short-term and long-term management of thrombotic diseases. However, the limitations of these traditional anticoagulants have prompted the development of new drugs. In the past 15 years new agents with improved safety profile and greater ease of use that target almost every step of the coagulation cascade have been developed. These include factor Xa inhibitors and direct thrombin inhibitors. The mechanism of action of these new anticoagulants and also the ‘older’ agents are reviewed in this article.
       
  • Hypovolaemia
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sally K. El-Ghazali, C. Stephanie Cattlin Hypovolaemia is defined as inadequate filling of the circulation and can be divided into absolute and relative hypovolaemia. The total body water accounts for 60% of a patient's body composition and is subdivided into extracellular and intracellular fluid compartments. The critical loss appears to be about 30% of the blood volume (1500–2000 ml). In order to limit the physiological effects of hypovolaemia, there are changes within the cardiovascular, renal and haematological systems to help minimize ongoing losses. The history and physical examination may give an indication that a patient is hypovolaemic. However, clinical signs may be a late manifestation of hypovolaemia as up to 15% of the blood volume can be lost before signs and symptoms are evident. It is of vital importance to measure fluid responsiveness in hypovolaemic patients to ensure patients are adequately resuscitated.
       
  • Ethical issues in resuscitation and intensive care
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Grant Lewis, Paul McConnell With continued advances in resuscitation and organ support, modern intensive care medicine is redefining life and death. Yet for all our progress, more life at any costs may not be an outcome that a patient wishes or finds tolerable. As medical paternalism is stripped away and the subjective wishes of the patient becomes the focus of our care, how we offer, deliver and discontinue therapies become paramount. When our patients themselves though may not be able to communicate their wishes as a result of both their pathology and our therapies in the intensive care unit, we are presented with ethical, moral and practical dilemmas as to how we may best care for them and act in their best interests.
       
  • Self-assessment
    • Abstract: Publication date: Available online 13 November 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Adjuvant agents in regional anaesthesia
    • Abstract: Publication date: Available online 9 October 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Mark Gallagher, Calum RK. Grant The addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic, although more recently a diverse range of adjuvants have been added to peripheral nerve block solutions, again with the aim of prolonging surgical anaesthesia. The evidence to support or refute the benefit of these agents is increasing, as is our understanding of which agents have demonstrable efficacy and safety at clinically appropriate doses. Clinicians must be aware that many adjuvants are not licensed for central neuraxial or perineural use and should be aware of the risks, in particular of neurotoxicity and unwanted side effects.
       
  • Self-assessment
    • Abstract: Publication date: Available online 9 October 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Regional anaesthesia in patients taking anticoagulant drugs
    • Abstract: Publication date: Available online 27 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Matthew R. Checketts Many surgical patients are taking drugs that impair normal coagulation, and this causes concern about the risk of perioperative bleeding events. The anaesthetist is particularly concerned about compressive vertebral canal haematomas that may occur after spinal or epidural anaesthetic techniques. Fortunately, the risk of this complication is very low. The major risk factors are coagulopathy or technical difficulties with the block. There is also concern about perineural haematomas that may be associated with peripheral nerve blocks. This article attempts to put the risks of these complications into context, with reference to different classes of anticoagulant drugs.
       
  • Techniques of epidural block
    • Abstract: Publication date: Available online 27 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Willie McClymont, Dan Celnick Epidural blocks are used for relief of chronic pain, labour pain and postoperative pain as well as for surgical anaesthesia. Effect can be targeted at the insertion level which can be from cervical spine level all the way to the sacral hiatus in the case of a caudal epidural block. Catheter insertion means doses can be repeated and the effect maintained. This contrasts with the typical single-shot spinal/subarachnoid injection primarily used for surgical anaesthesia. Specifically avoiding dural puncture also contrasts with the spinal's simple endpoint of detecting CSF. Accurate epidural needle insertion is therefore technically more difficult. The variety of methods available to identify if the needle tip is in the epidural space highlights this much less certain endpoint. With epidural injections, drug solutions need to physically spread to access each intended nerve root. This makes epidurals less reliable than spinals, where simply depositing the solution in the CSF rapidly enables it to bathe all the nerve roots encountered. Serious risks such as direct damage to nerve tissue, infection and epidural haematoma are shared with spinal anaesthesia but may be more likely with epidural techniques. Epidural needles are wider bore and more likely to damage tissue and vessels. They are sometimes directed close to the spinal cord itself. In-dwelling catheters can move and traumatize vessels and act as a focus for infection. Despite these potential drawbacks, careful selection, skilled placement and management mean patients can safely derive the intended benefits and epidurals and caudal blocks continue to be popular.
       
  • Medical gases
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): William Malein, Christina Beecroft Understanding the complex process of production, storage and delivery of medical gases is vitally important to ensure safe and efficient practice by anaesthetists. This article discusses the medical gases commonly used in anaesthesia and intensive care, and details the journey of the commonly used medical gases from production to patient delivery. It includes core knowledge for the FRCA.
       
  • Premedication
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Will Watson, Adam Capek Premedication is an important part of preoperative management of all patients. It involves the optimization of underlying medical conditions and implementation of risk reduction therapies. Anxiolytic medications still have a place, particularly in certain patient populations. Important classes of drugs to consider in the perioperative period are cardiovascular drugs, anticoagulants and antiplatelets. Aspiration prophylaxis is the main risk-reduction therapy used. Benzodiazepines are still the mainstay of anxiolysis treatment, while topical anaesthesia can be used to aid cannula insertion. The most important aspect is thorough assessment of each patient, and tailoring the premedication to their specific needs.
       
  • Patient positioning in anaesthesia
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Dominic O'Connor, Jeremy Radcliffe Anaesthesia inhibits a variety of the protective mechanisms usually in place to protect us from harm and prevent damage to vulnerable tissues. In addition, anaesthesia and patient positioning may impose physiological stresses on these tissues. Patients are often required to assume positions for surgery which would be intolerable without anaesthesia; these positions may introduce hazards which can lead to injury. Positioning of patients under anaesthesia is an important subject for anaesthetists to consider, since patient positioning has implications upon the patient's physiological responses as well as potentially causing injury to the patient. We describe the considerations for the anaesthetist when positioning the surgical patient. We discuss the positions commonly used for surgical patients and relate the challenges associated with each of these positions, challenges which can be physical as well as physiological. Staffing and equipment provision levels must be adequate to cope with the complexity predicted in positioning an individual patient. The anaesthetist also needs to consider the relatively restricted access to the patient for intervention when in the prone or lateral positions.
       
  • Spinal anaesthesia
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Amy LK. Sadler, Paul DW. Fettes Spinal anaesthesia involves the injection of local anaesthetic solution into the intrathecal space. It is a widely practiced anaesthetic technique that can provide surgical anaesthesia for procedures below the umbilicus. Due to the proximity of the central nervous system, safe practice is of paramount importance and requires a good understanding of relevant anatomy, physiology and pharmacology. Complications are rare but need to be recognized and managed rapidly and appropriately.
       
  • Does regional anaesthesia improve outcome'
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Kathryn Hill, Alan JR. Macfarlane Outcome after surgery is of interest to the patient, the surgeon and the healthcare institution. There is conclusive evidence that regional anaesthesia is associated with superior analgesic outcomes compared to opioid-based analgesic techniques and may also reduce chronic pain. While better pain control and avoiding a general anaesthetic may alone be regarded as significant outcome benefits, regional anaesthesia and analgesia may influence many other important outcomes. Regional anaesthesia clearly reduces postoperative nausea and vomiting and pulmonary complications compared to general anaesthesia. Regional anaesthesia independently reduces length of stay and is a common component of enhanced recovery packages. Contemporary, but less robust, data suggests that neuraxial anaesthesia, and to a lesser extent analgesia, may reduce blood transfusion requirements, surgical site infection, intensive care admission, cancer recurrence and maybe even mortality. Any functional outcome benefits secondary to regional anaesthesia appear to be short lived and are generally not sustained long term.
       
  • Safety considerations and risks of transfusion
    • Abstract: Publication date: Available online 22 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Jessica Sandham, Balsam Altemimi Cross-matching of blood components to the patient's blood is mandatory to ensure the safe transfusion of suitable blood components in a timely manner and avoid serious harm to the recipient. This article will outline the validated methods of cross-matching in the laboratory setting. We will also discuss transfusion reactions and consequences of transfusion of inappropriate or mismatched blood components, alongside the principles of patient blood management and pre-operative anaemia.
       
  • Measuring temperature
    • Abstract: Publication date: Available online 19 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): E Byron Howells In the perioperative period patients tend to lose heat and become hypothermic. An understanding of the causes and prevention of heat loss is therefore important to the anaesthetist. Heat and temperature are measures of energy. Heat is a measure of the total kinetic energy (joules, J) of a body, and depends on the size of the body and its specific heat capacity. Temperature is a measure of the average kinetic energy, and describes the potential for heat transfer from a body at high temperature to one at lower temperature until both bodies reach equilibrium at the same temperature. Temperature is measured on a scale (e.g. Fahrenheit, Celsius or Kelvin) that is defined by fixed points related to predictable physical events (e.g. the freezing point, steam point and triple point of water).
       
  • The immunology of solid organ transplantation
    • Abstract: Publication date: Available online 19 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stephen R. Knight, Ala Alasadi, Marc Clancy Solid organ transplantation has progressed dramatically over the last 50 years. However, rejection still remains one of the barriers to successful transplantation. Immunological processes underlying the mechanisms of rejection are well described and numerous pharmacological agents exist to help suppress a recipient's immune system in order to prolong graft survival. Furthermore, clinician decisions and actions during both the work-up of a potential transplant recipient and in the perioperative phase can impact upon the immunological status of an individual and the likelihood of successful solid organ transplantation. In this article we aim to describe the key processes involved in solid organ immunology and their relevance in anaesthetic practice.
       
  • The immune system
    • Abstract: Publication date: Available online 11 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Malcolm Howell, Malcolm Shepherd This article intends to provide an up-to-date overview of the relevant physiology required to pass the FRCA. The immune system is our defence against pathogens. This includes the recognition of non-self organisms, and protection through a variety of non-specific and highly specific mechanisms. Failure of the immune system leads to immunodeficiency or immunopathology either may be catastrophic for the host.
       
  • Brain stem death
    • Abstract: Publication date: Available online 10 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Richard Cowan, Barbara Miles The concept of brain and brain stem death developed from the observation of apnoeic comatose patients. In the UK, the diagnosis of brain stem death is made by clinically testing brain stem function once specific preconditions have been met. The exact definition of brain death and some details regarding the tests required to make this diagnosis vary across the globe. However, the majority of tests carried out are similar to those in the UK. In this review we define brain stem death and the clinical tests used to confirm it. The use of ancillary testing can have a role in patients where clinical tests are not possible and this is also discussed.
       
  • Organ donation and management of the potential organ donor
    • Abstract: Publication date: Available online 8 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Gilly Fleming, Euan M. Thomson Solid organ transplant offers the potential of disease-free survival for hundreds of thousands of patients worldwide. Transplantation not only increases life expectancy and improves quality of life, but offers long-term financial savings to health care systems. The clinician's role in early identification and management of potential donors ensures that the maximum benefit can be gained from the gift of donation. A chronic shortfall in transplantable organs has led to broadened inclusion criteria for donors, and a move towards presumed consent models for donation. Protocolized and goal-directed donor management with early involvement of the transplant multidisciplinary team increases both the quality and quantity of grafts successfully donated.
       
  • Anaesthesia and intensive care for adult liver transplantation
    • Abstract: Publication date: Available online 8 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Craig Beattie, Michael A. Gillies This review describes the preoperative assessment and listing of the patient for liver transplantation and some of the perioperative challenges specific to this group of patients. The principles of the postoperative management in the intensive care unit are discussed as well as some of the signs of early graft dysfunction. Increasingly complex patients with advanced liver disease are receiving grafts from more marginal donors and this can present significant challenges to the transplant team. The anaesthetist and intensivist play a vital role in determining outcome in the perioperative period and must work collaboratively with surgeons and hepatologists to achieve the best patient outcomes.
       
  • Inflammation, immunity and allergy
    • Abstract: Publication date: Available online 7 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Darryl Stewart, Alistair Nichol Injury or foreign invasion will instigate a cascade of events directed at eliminating the intruder and augmenting the healing process. This involves the unification of two separate processes (inflammatory and immune processes) to provide an effective host defence. Chemical mediators converge on the site of tissue damage and exert local and distant effects. The immune response is divided into innate and acquired immunity. The immediate, non-specific innate response, combined with the specifically targeted acquired response, provide our major defence mechanisms. Lymphocytes and immunoglobulins are the hallmark of acquired immunity. Regulation of these interlinked systems provide cohesion and a group of soluble proteins called cytokines have a major role. Protective immune mechanisms can sometimes cause detrimental effects to the host. We discuss and classify allergic reactions, in particular, the most severe and potentially life threatening form – anaphylaxis.
       
  • Organization and composition of body fluids
    • Abstract: Publication date: Available online 7 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Mark A. Henderson, Stuart Gillon, Mo Al-Haddad Disorders of fluid balance and electrolyte homeostasis are commonly observed in critically ill patients and in those who require emergency anaesthesia. Consequently, anaesthetists and intensive care physicians must understand the physiological principles that govern fluid balance. This article discusses the compartmentalization of total body water and describes methods by which the volume of the fluid compartments may be measured. The novel concept of the endothelial glycocalyx is discussed in addition to the conventional and contemporary models of capillary filtration dynamics. The core elements of fluid balance and cardiovascular homeostasis are also explored.
       
  • Self-assessment
    • Abstract: Publication date: Available online 6 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Cardiopulmonary transplantation
    • Abstract: Publication date: Available online 6 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Mark Buckland, Bronwyn Scarr, Chris Durkin Heart and lung transplantation rates continue to rise with median survival rates of 11 and 7.4 years, respectively, with transplantation becoming the definitive therapy for end-stage disease of each system. Indications for lung transplantation are categorized as suppurative, obstructive, restrictive and pulmonary vascular. Surgical options include single lung, bilateral sequential single lung and heart–lung transplantation. Each has their own intraoperative challenges, especially at induction, commencement of positive pressure ventilation, one-lung ventilation, pulmonary artery clamping and lung reperfusion. A double lumen tube and a period of one lung ventilation is generally required for cases performed without cardiopulmonary bypass. Strategies to reduce pulmonary pressures and support right ventricular function are important. Perioperative fluids are minimized and lung protective strategies implemented to optimize lung function. Thoracic epidural anaesthesia is commonly used for postoperative pain management. The most common indication for heart transplantation is non-ischaemic cardiomyopathy. Ventricular assist devices and inotropic infusions are often used as a bridge to transplantation. Communication between donor and recipient teams is critical. Reversal of anticoagulation and alteration of implanted medical devices may be necessary. Anaesthetic management requires invasive monitoring, optimization of ventricular function and preparation for coagulopathy. Right ventricular dysfunction is the leading cause of early mortality.
       
  • Ethical issues in organ transplantation
    • Abstract: Publication date: Available online 3 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Lucy Modra, Andrew Hilton Critical care clinicians are central to the organ transplantation process and therefore should be aware of the myriad ethical issues it raises. Organ donation can transform the lives of transplant recipients. However, it also warrants particular ethical scrutiny. Organ procurement is a procedure that cannot physically benefit the patient upon whom it is performed. Moreover, the potential donor incapacitated by terminal illness is usually unable to actively consent to donation. This article reviews contemporary debates in vital organ transplantation, including the definition of death, perimortem interventions and research, and merits of ‘opt-in’ versus ‘opt-out’ donor registries.
       
  • Anaesthesia for renal transplantation
    • Abstract: Publication date: Available online 3 September 2018Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emily Robertson, Neil Logan, Nick Pace This article describes the assessment of the patient for renal transplantation, the perioperative management and the aims in the post-operative period. These patients present a unique set of challenges to the anaesthetist, who has a crucial role in the immediate success of the transplanted organ.
       
 
 
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