for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3120 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

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

Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 31, 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: 382, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, 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   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 241, 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: 25, 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: 6)
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: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 143, 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: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 26, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, 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: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, 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: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, 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: 53, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, 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: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
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: 37, 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 Intl. Accounting     Full-text available via subscription   (Followers: 4)
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: 10)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
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: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, 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: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 16, 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: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 7)
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: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 374, 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: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, 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: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 344, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 438, 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: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, 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: 11, 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   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
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: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 209, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
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: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, 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: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
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: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 37, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 174, 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: 12)
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   (Followers: 1)
Animal Behaviour     Hybrid Journal   (Followers: 180, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

        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]   [60 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1472-0299
   Published by Elsevier Homepage  [3120 journals]
  • Self-assessment
    • Authors: Viyayanand Nadella
      Pages: 462 - 463
      Abstract: Publication date: December 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 12
      Author(s): Viyayanand Nadella


      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.07.001
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      First page: 161
      Abstract: Publication date: Available online 8 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.01.001
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      First page: 161
      Abstract: Publication date: Available online 27 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.01.001
       
  • Anaesthesia for thoracic surgery
    • Authors: William Simpson
      Pages: 593 - 597
      Abstract: Publication date: December 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 12
      Author(s): William Simpson
      Thoracic anaesthesia is an expanding and evolving sub-speciality. This article will focus primarily on the anaesthetic management of major lung resections, procedures which are generally performed for malignant disease and which can confer significant mortality and morbidity. The equipment needed and ventilatory strategies during one lung anaesthesia will be discussed and the important changes in respiratory physiology that occur will be looked at in detail. Recent advances in pain management necessitate that postoperative analgesic regimens are covered in some depth. There has been an increase in the number of video-assisted thoracoscopic surgery (VATS) cases and the merits and anaesthetic implications of VATS procedures are reviewed.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.09.010
       
  • Analgesia for thoracic surgery
    • Authors: Rebecca Oram; Neil Rasburn
      Pages: 606 - 608
      Abstract: Publication date: December 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 12
      Author(s): Rebecca Oram, Neil Rasburn
      Pain following thoracic surgery is often severe and can be due to retraction, fracture or dislocation of ribs, injury of intercostal nerves or irritation of pleura by chest tubes. A good, multimodal analgesic strategy is required to keep the patient comfortable postoperatively and minimize the risk of pulmonary complications. Inadequate pain control may lead to respiratory failure secondary to splinting, or pneumonia as a result of an ineffective cough and poor clearance of secretions. High-intensity postoperative pain can also facilitate the development of post-thoracotomy pain syndrome, which can be severe and incapacitating. Effective analgesia is a key part of enhanced recovery and techniques are required to aid patient mobilization around the ward postoperatively whilst minimizing discomfort and need for cumbersome infusion lines and pumps.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.09.009
       
  • Anaesthesia for surgery of the trachea and main bronchi
    • Authors: Michael Charlesworth; Alan Ashworth
      Pages: 614 - 619
      Abstract: Publication date: December 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 12
      Author(s): Michael Charlesworth, Alan Ashworth
      The anaesthetic challenges of major tracheobronchial surgery relate to airway control, ventilation management, maintaining optimal surgical exposure and appropriate patient selection. Although such surgery is generally performed in specialist centres, the strategies for dealing with central airway obstruction and bronchoscopy under general anaesthesia are of broader importance. Furthermore, an intra-thoracic airway obstruction presents difficulties that require a different mindset to the more familiar scenario of an extra-thoracic airway obstruction. Tracheal stenosis following a period of prolonged tracheal intubation is now the leading indication for tracheal resection. A standard approach involves total intravenous anaesthesia, a right-sided arterial line, epidural analgesia and early extubation. Usually, a sterile armoured cuffed endotracheal tube is placed under direct surgical vision for the period of segmental resection followed by reintroduction of the native orotracheal tube under bronchoscopic vision for the primary end-to-end anastomotic reconstruction.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.09.002
       
  • Respiration: control of ventilation
    • Authors: Emrys Kirkman
      Pages: 630 - 633
      Abstract: Publication date: December 2017
      Source:Anaesthesia & Intensive Care Medicine, Volume 18, Issue 12
      Author(s): Emrys Kirkman
      Rhythmic ventilation is an automatic process controlled by the central nervous system. Groups of cells in the brainstem, predominantly the ventral and dorsal respiratory groups, are responsible for generating basic respiratory rhythm. This basic rhythm is subject to modulation by both conscious and reflex actions. In normal individuals the respiratory minute volume is set to closely regulate arterial carbon dioxide tension (PaCO2) at approximately 5.3 kPa, predominantly via a negative feedback reflex involving the central chemoreceptors. A separate group of chemoreceptors, the arterial chemoreceptors, are responsible for initiating the increased ventilatory response to counter arterial hypoxia, but a brisk response is not seen until PaO2 levels fall to approximately 8.0 kPa from the normal 13.3 kPa. Combined hypercarbia and hypoxia (asphyxia) is a very powerful stimulus to breathe as the two inputs interact in a synergistic manner. The chemoreceptor reflexes can be modified when the need arises (e.g. blockade of the respiratory part of the arterial chemoreflex by the trigeminal reflex as part of the diving response). Other reflexes such as the Hering–Breuer reflex contribute to setting the balance between tidal volume and respiratory rate to attain a given minute volume, although this reflex does not appear to play a major role in humans at resting tidal volumes. Superimposed on this ‘tonic’ control, additional protective reflexes (e.g. from receptors in the upper airways) are recruited to protect the lungs and airways with responses such as coughs and sneezes when required.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.09.006
       
  • Gastric disorders: modifications of gastric content, antacids and drugs
           influencing gastric secretions and motility
    • Authors: Zoë Whitman; Daniel H.R. O'Neil
      Abstract: Publication date: Available online 6 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Zoë Whitman, Daniel H.R. O'Neil
      Gastric disorders have clinical implications in both anaesthesia and critical care medicine. Aspiration of acidic gastric contents in the perioperative setting is linked to pneumonitis and later development of pneumonia. Pharmacological strategies to minimize this risk include histamine-2 receptor antagonists, sucralfate, proton pump inhibitors and sodium citrate. Use of gastric acid suppressing therapy is widespread in intensive care units to reduce the incidence of stress-related mucosal bleeding. Intestinal failure is common in critical illness. Medications that decrease gastric motility and contribute to ileus include opioid analgesics, catecholamines and α2-adrenoceptor antagonists. Current pharmacological strategies for increasing gastric motility include the use of metoclopramide and erythromycin, either alone or in combination, though their effectiveness in clinical practice is limited. A range of further medications, with different drug targets, are being investigated as alternatives. These include specific motilin receptor agonists, peripherally acting opioid receptor antagonists, cholecystokinin antagonists, 5HT4 antagonists and cholinesterase inhibitors.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.011
       
  • Clinical negligence
    • Authors: Robert Palmer; Mary C. Maclachlan
      Abstract: Publication date: Available online 6 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Robert Palmer, Mary C. Maclachlan
      Clinical negligence cases are based on the assumption that a doctor owes patients a duty to take reasonable care when treating or advising them. Doctors breach this duty if their treatment falls below the standard expected by a responsible body of medical opinion. The doctor will be held to have acted negligently. A patient may then have a claim for compensation if, and only if, the patient can prove, on the balance of probabilities, that the negligence has caused physical or emotional injury. A claim must be commenced within 3 years of when the injury occurred or it will be time barred.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.004
       
  • Central nervous system stimulants: basic pharmacology and relevance to
           anaesthesia and critical care
    • Authors: Ryan Campbell; Simon P. Young
      Abstract: Publication date: Available online 2 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ryan Campbell, Simon P. Young
      Central nervous system (CNS) stimulants are common in clinical practice, and have a high potential for abuse. The CNS stimulants can be classified as analeptic stimulants, psychomotor stimulants, or methylxanthines. Doxapram activates peripheral chemoreceptors and central respiratory centres in a dose-dependent manner. Psychomotor stimulants (e.g. cocaine and amfetamines) increase sympathetic nervous system activity. Competition for various metabolic and transport processes can lead to dangerous drug interactions. Sympathomimetics in the perioperative period may result in haemodynamic instability, cardiac dysrhythmias, and myocardial ischaemia. Therapeutic methylxanthines are used mainly to stimulate respiratory centres.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.008
       
  • Drugs and the liver
    • Authors: Rakesh Vaja; Navreet Ghuman
      Abstract: Publication date: Available online 1 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Rakesh Vaja, Navreet Ghuman
      The liver is a major organ with multiple functions. A number of drugs are metabolized by the liver during phase 1 and 2 reactions which include complex processes involving cytochrome P450 enzymes. Genetic and acquired variability in cytochrome P450 activity may have profound effects on pharmacokinetics. Additionally, drugs can also modify how the liver functions and cause dysfunction or even failure of the organ both by a direct effect on the liver or by alteration in liver blood flow. It is important to recognize the signs and symptoms of liver failure in patients and identify possible causes including drug interactions. Furthermore, once a patient has been recognized to be suffering with liver dysfunction or failure, drug choice and dosing regime will need to be rationalized. Paracetamol overdose can have severe and life-threatening consequences for patients due to its effect on liver function. It is the leading cause of acute liver failure in the UK. Correct and early management is crucial and will be discussed within this article.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.006
       
  • Laboratory tests in liver failure
    • Authors: Frances Lui
      Abstract: Publication date: Available online 1 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Frances Lui
      Liver function test is one of the most commonly performed laboratory investigations and consists of a panel of laboratory measured serum parameters. It does not evaluate function of the liver directly but interpretation, as a panel, reflects underlying hepatocellular injury, metabolic and synthetic functions of the liver and supplement clinical assessment. It assists diagnosing liver failure, serial monitoring of disease progress, classifying severity and scoring systems, and selection of candidates and extent for liver resection, extracorporeal support devices and liver transplantation. An understanding of laboratory liver function tests is considered a basic scientific knowledge in clinical anaesthesia and critical care.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.003
       
  • Suction devices
    • Authors: Larissa Latif; Jamie Macdonald
      Abstract: Publication date: Available online 1 December 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Larissa Latif, Jamie Macdonald
      Suction devices are integral to the safe delivery of anaesthesia and critical care. They are involved in clearing and aspirating body fluids, blood and debris, as well as employed in scavenging waste gases and diathermy fumes, intraoperative cell salvage systems, and tertiary devices such as vacuum mattresses and specialized wound dressings. All suction devices require three essential components, namely a source of vacuum, a reservoir/collection vessel and suction tubing. Other components of a suction device include an on/off switch, a vacuum regulator, vacuum gauge, filters, an overflow safety trap, an overfill protection device in the collection vessel, and a catheter. Several different types of catheter are available for use in different clinical situations. Vacuum and flow are the main physical principles underlying suction devices. The source of vacuum may be a fixed centrally piped system or a portable device using electrical, pneumatic or manual power. Pneumatically powered suction devices utilize the Bernoulli principle and Venturi effect. The efficiency of each system depends upon principles of displacement, degree of negative pressure and time taken to reach this, the internal resistance of the suction apparatus and the viscosity of the material to be aspirated.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.010
       
  • Anaesthesia and minimally invasive surgery
    • Authors: Stanley Sau Ching Wong; Michael G. Irwin
      Abstract: Publication date: Available online 28 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Stanley Sau Ching Wong, Michael G. Irwin
      Minimally invasive surgery is commonly performed because of various advantages such as reduced postoperative pain, faster recovery, and reduced postoperative pulmonary complications. However, anaesthesia for laparoscopy can be difficult and potentially hazardous in long, complex surgical procedures and in those with significant co-morbidity. Establishment of carbon dioxide (CO2) pneumoperitoneum produces adverse pathophysiological changes due to increased intraabdominal pressure and hypercapnia, and these are further altered by postural changes. Laparoscopy is also associated with potential complications such as extraperitoneal gas insufflation and pneumothorax. It is important for the anaesthetist to understand the advantages and potential risks. General anaesthesia is most commonly used but neuraxial anaesthesia is possible, although spontaneous ventilation may be difficult. Endotracheal intubation has been a popular technique but supraglottic airway devices are less traumatic, easier to insert and more modern versions provide a good airway seal as well as gastric drainage, should it be required. This article will focus on the pathophysiological changes caused by CO2 pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.005
       
  • Clinical aspects of hepatic disease
    • Authors: Czarina CH. Leung; Karl K. Young
      Abstract: Publication date: Available online 27 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Czarina CH. Leung, Karl K. Young
      Liver disease has a high prevalence in all parts of the world. Patients with advanced liver disease have poor outcome after surgery. Prognostic scoring systems help to identify patients at high risk. Chronic liver disease is associated with impaired hepatic synthetic and metabolic functions as well as typical extra-hepatic manifestations, resulting from failure to clear endogenous vasodilators, splanchnic vasodilation, high cardiac output and decreased central blood volume. Some patients may develop complications, including hepatorenal syndrome, hepatopulmonary syndrome and porto-pulmonary hypertension. In fulminant liver failure, cerebral oedema is a prominent feature. Without liver transplantation, these patients have a dismal prognosis. Appreciation of the multi-system sequelae of liver disease is a prerequisite to appropriate management.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.009
       
  • Anaesthesia for gastrointestinal surgery
    • Authors: Rhys Davies; Ingrid Wilkins
      Abstract: Publication date: Available online 27 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Rhys Davies, Ingrid Wilkins
      Patients with gastrointestinal disease will present with a range of nutritional, fluid and electrolyte disturbances. This article will discuss how to recognize these problems and try to minimize their impact on recovery. A growing body of evidence shows that adoption of a package of care known collectively as enhanced recovery significantly reduces postoperative morbidity and reduces length of hospital stay. For anaesthetists the changes involve analgesic regimens and perioperative fluid and nutrition management. This evidence has been brought together in the national Enhanced Recovery After Surgery Programme and has been introduced to many hospitals for elective bowel surgery patients. The principles of the programme will be discussed. Aspects of it can be applied to many other surgical groups.

      PubDate: 2017-12-12T06:46:23Z
      DOI: 10.1016/j.mpaic.2017.10.002
       
  • Respiratory system: applied pharmacology
    • Authors: Jonathan Brand; Joseph E. Arrowsmith
      Abstract: Publication date: Available online 15 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Jonathan Brand, Joseph E. Arrowsmith
      Knowledge and application of respiratory pharmacology is essential for both anaesthetists and intensive care physicians. Patients often present with co-existing respiratory disease for which they may be taking prescription medications. Respiratory function is often altered by anaesthetic drugs and interventions, therefore an in-depth understanding of respiratory pathophysiology and pharmacology is required in order to safely treat these patients. This article describes the basics of the bronchial tone, the ability of the lung to handle and metabolize drugs in addition to discussion of the drugs that can be used to alter bronchial tone and pulmonary vascular resistance.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.001
       
  • Basic principles of lasers
    • Authors: Daniel Haley; Oliver Pratt
      Abstract: Publication date: Available online 15 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Daniel Haley, Oliver Pratt
      The theoretical basis for laser was first described by Einstein, 100 years ago. Lasers are now in widespread use and have an extensive range of applications, including many within the field of medicine. This article explores the properties of laser; its physical principles; and the main components required to produce a laser beam. The specific properties of laser render it an extremely useful clinical tool in a variety of circumstances. The application of laser also brings potential hazards, which are discussed, along with the safety measures utilised to minimize the associated risk.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.10.001
       
  • Measurement of gas concentrations
    • Authors: Alastair Duncan; Oliver W. Pratt
      Abstract: Publication date: Available online 14 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Alastair Duncan, Oliver W. Pratt
      Gas analysis is one of the minimum standards of monitoring for any patient undergoing anaesthetic intervention. Side stream analysers are commonly employed to allow for measurement of gas concentrations. The systems used to measure oxygen (O2) concentration include the paramagnetic analyser, the Clark electrode and the fuel cell. Infrared absorption spectroscopy is used to measure carbon dioxide (CO2), nitrous oxide (N2O), and volatile anaesthetic agents in gaseous form. Refractometry, piezoelectric absorption, Raman scattering, and mass spectrometry may also be used. The Severinghaus electrode is used to measure CO2 concentration in solution. This article will provide an overview of the techniques used for gas analysis and their associated potential sources of error.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.011
       
  • Common errors in clinical measurement
    • Authors: Ming Wilson
      Abstract: Publication date: Available online 14 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ming Wilson
      In modern anaesthetic practice, the use of progressively sophisticated measuring devices increases the possibility of erroneous measurements. This can potentially result in misguided decision-making and patient harm. Anaesthetists must be aware of the limitations of these devices and their sources of error. This article will discuss the errors associated with equipment used in daily anaesthetic practice including capnography, electrocardiography, invasive and non-invasive blood pressure, and pulse oximetry.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.008
       
  • Tests of pulmonary function before thoracic surgery
    • Authors: Neil G. Britton; Matthew Stagg
      Abstract: Publication date: Available online 14 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Neil G. Britton, Matthew Stagg
      Respiratory function declines following surgery due to atelectasis. After thoracic surgery, there is an even greater decline due to resection and lung handling. Patients undergoing thoracic surgery often have concomitant respiratory disease and testing pulmonary function pre-operatively allows: diagnosis and optimization of lung disease; counselling of patients accurately to obtain truly informed consent and guide the multidisciplinary team to the best operation. Tests of pulmonary function can be divided into tests of mechanical function, tests of parenchymal function, tests of cardiorespiratory reserve and function, and anatomical tests. When these tests are combined with knowledge of the lobes resected they allow predicted postoperative values to be calculated. Evidence-based guidelines show which investigations should be performed preoperatively and risk-stratify patients for postoperative dyspnoea, morbidity and mortality.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.003
       
  • Measurement of pulse oximetry, capnography and pH
    • Authors: Andrew J. Deacon; Oliver W. Pratt
      Abstract: Publication date: Available online 11 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Andrew J. Deacon, Oliver W. Pratt
      The measurement of arterial oxygen saturations, end-tidal carbon dioxide and pH are all key to modern anaesthetic practice. They can all be measured in a variety of ways but with the most common being discussed in the article. The understanding of the underlying physical principles and how the anaesthetist monitors function to measure these variables is discussed in this article, including limitations and inaccuracies of each technique.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.004
       
  • Respiration: ventilation
    • Authors: James Cameron; Upma Misra
      Abstract: Publication date: Available online 11 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): James Cameron, Upma Misra
      Ventilation is the process by which air moves into and out of the lungs and is made available for gas exchange. Weibel's description divided the lungs into a conductive zone and a respiratory zone of 23 generations of dichotomously branching airways. Gas flow within the proximal airways is in the form of bulk movement and via diffusion in the distal airways. Resistance to gas flow in the airways is determined by a number of factors. Airway radius is the most important factor influencing resistance and gas flow changes from being turbulent proximally to laminar distally. Inspiration is an active process. The diaphragm is the main muscle of inspiration. Expiration is normally a passive process during quiet breathing but requires energy expenditure during certain actions (e.g. coughing). Ventilation is not evenly distributed throughout the lungs and distribution is related to the compliance of alveoli in different areas. Under normal circumstances, in the standing position, basal alveoli are the most compliant and are therefore preferentially ventilated. Ventilation occurs automatically in a continuous rhythmic pattern without conscious effort. It is controlled by neural and chemical inputs and is concerned with the homeostasis of oxygen and carbon dioxide and acid–base balance.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.012
       
  • Fibreoptic bronchoscopic positioning of double-lumen tubes
    • Authors: Karen A. Foley; Peter Slinger
      Abstract: Publication date: Available online 11 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Karen A. Foley, Peter Slinger
      Double-lumen tubes (DLTs) should be placed using a fibreoptic bronchoscope. This allows correct positioning of the bronchial lumen in the chosen mainstem bronchus. It also ensures that the blue bronchial cuff does not obstruct the side to be ventilated when it is inflated under direct vision. Fibreoptic bronchoscopy facilitates correct positioning of the ventilatory side slot of a right DLT over the right upper lobe bronchus. The anaesthetist must know the fibreoptic tracheo-bronchial anatomy to properly position left- and right-sided DLTs and should always reconfirm the position of a DLT with fibreoptic bronchoscopy after repositioning the patient. Maintaining orientation (anterior-posterior) during fibreoptic bronchoscopy is crucial to positioning a DLT, particularly after the patient has been turned to the lateral position. A fibreoptic bronchoscope can also be used as a guide to direct a DLT under direct vision into its correct position.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.005
       
  • Fluid balance
    • Authors: Emrys Kirkman; Peter Tryphonopoulos; Christopher Harle
      Abstract: Publication date: Available online 11 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Emrys Kirkman, Peter Tryphonopoulos, Christopher Harle
      The primary function of the lung is gas exchange between alveolar gas and the blood flowing through the nearby capillaries. This stage of gas exchange takes place by diffusion. Because gases such as oxygen diffuse relatively slowly through liquids it is essential that the fluid barrier is kept as short as possible. Furthermore, it is vital that interstitial fluid does not escape into the alveoli because this would abolish gas exchange in the flooded alveoli and lead to shunt. The net movement of these fluids is largely determined by the Starling forces. A number of physiological mechanisms normally ensure that fluid that does leave the pulmonary microvasculature is quickly removed and hence gas transfer is not impaired. The lungs, in addition, perform a number of other important non-respiratory functions, including modification of circulating levels of a range of biologically active materials, filtration of blood and serving as a reservoir of blood for rapid adjustment of input to the left atrium when needed.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.013
       
  • Airway apparatus for thoracic surgery
    • Authors: K. George Lee
      Abstract: Publication date: Available online 11 November 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): K. George Lee
      One-lung anaesthesia is becoming mandatory for thoracic operations; knowledge of the required apparatus is essential for anaesthetists. Developed in the 1950s from non-anaesthetic apparatus, the double-lumen endobronchial tube (DLT) remains the most widely used piece of equipment in this field. The early rubber tubes are giving way to modern plastic, but the principle and function of the DLT remains unchanged. The introduction of robust fine flexible bronchoscopes (FB) has improved the positioning of tubes, and also stimulated the reintroduction of bronchus blockers. Miniature video cameras have recently been incorporated into both tracheal tubes and flexible bronchoscopes, improving visualization of the lower airway during anaesthesia. This article outlines the development and use of the currently available DLTs and bronchus-blockers. It concludes with comparison of the two methods of lung isolation.

      PubDate: 2017-11-18T11:35:05Z
      DOI: 10.1016/j.mpaic.2017.09.007
       
  • Transporting critically ill children
    • Authors: Peter-Marc Fortune; Kate Parkins; Stephen Playfor
      Abstract: Publication date: Available online 10 October 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Peter-Marc Fortune, Kate Parkins, Stephen Playfor
      Increasing centralization of paediatric intensive care services and a reduction in the numbers of children cared for in adult intensive care units over the last 15–20 years has led to an increase in the numbers of critically ill children being transferred between clinical centres throughout the UK. Seventy-seven per cent of these retrievals are conducted by a specialist paediatric intensive care unit (PICU) team, the remainder by various other teams (with and without specialist intensive care experience). Various pressures made it increasingly difficult for PICUs to facilitate the timely retrieval of critically ill children whilst maintaining the provision of quality care to children already under their supervision. This situation has led to the development of regional, stand-alone transport teams throughout the UK. A typical example of such a team is the North West & North Wales Paediatric Transport Service (NWTS). This team uses the structured approach ‘ACCEPT’, advocated by the Advanced Life Support Group, Neonatal, Adult and Paediatric Safe Transfer and Retrieval (NAPSTaR) course. This acronym summarizes the key components of transfer: Assessment, Control, Communication, Evaluation, Preparation/Packaging, Transportation and places the evaluation, planning and execution of these elements in context by considering the defining features of transport medicine summarized as ‘SCRUMP’: Shared assessment, Clinical isolation, Resource limitations, Unfamiliar equipment, Movement and Safety and Physiology. Regional transport teams have improved patient outcomes and experiences when compared to previous models of service delivery. The approach used by these services may be adopted by all teams providing intra- and inter-hospital transfer of the sick or injured child.

      PubDate: 2017-10-13T18:08:52Z
      DOI: 10.1016/j.mpaic.2017.08.002
       
  • Transfusion guidelines in children: I
    • Authors: Helen Jones; Katherine Reeve
      Abstract: Publication date: Available online 4 October 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Katherine Reeve, Helen Jones
      The transfusion of a blood product to a child is associated with a greater risk of harm when compared to an adult. Transfusion is necessary in certain situations and so the benefits have to be balanced against potential adverse events. This article will present information concerning blood transfusion thresholds in children, calculations for maximal tolerated blood loss and the concept of massive transfusion protocols.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.004
       
  • Special considerations in paediatric intensive care
    • Authors: Cheryl E. Peters; Alexander F. Pitfield; Norbert R. Froese
      Abstract: Publication date: Available online 29 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Cheryl E. Peters, Alexander F. Pitfield, Norbert R. Froese
      The modern-day paediatric intensive care unit (PICU) is staffed and equipped to provide care to the most critically ill children. It is by definition a low-volume, high-cost service. High staff-to-patient ratios are required both because of the potentially rapid evolution of critical illness in children and because of the complexity of the supportive therapy offered. Children are admitted to the PICU with a wide variety of medical illnesses and following diverse surgical procedures. Treatment strategies are complex. Although definitive evidence for specific paediatric therapies is often limited, international collaborative efforts have produced consensus treatment guidelines that serve to promote the use of best practice therapies. This article reviews critical therapies and techniques that define care in the PICU, and outlines the management of acute lung injury, traumatic brain injury and septic shock. Neonatal and cardiac intensive care medicine topics are outside the scope of this article.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.007
       
  • Trauma and burns in children
    • Authors: Mairi Crawford; Jon G. McCormack
      Abstract: Publication date: Available online 28 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Mairi Crawford, Jon G. McCormack
      Trauma is the leading cause of death and disability in children, most often resulting from blunt trauma. An immediate co-ordinated and pathology-focussed resuscitation will contribute to improved morbidity and mortality outcomes. This article discusses the principles of the primary and secondary survey in injured children and outlines the management of children suffering from burns. A multi-professional approach to the treatment of critically injured children should be adopted; where the primary survey aims to identify and manage catastrophic haemorrhage followed by management of life-threatening injuries to airway, breathing and circulation. The secondary survey includes a detailed examination to identify and manage other subtle or less severe injuries. Attention to fluid therapy, analgesia, thermoregulation, blood coagulation and glucose homeostasis form important aspects of this secondary survey. Children injured in fires may have suffered from smoke inhalation or sustained burns to the upper airway, with rapid swelling of mucosal tissue, which can make immediate control of the airway very challenging. Both flame burns and scalds can cause significant fluid losses and are associated with a significant risk of mortality.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.006
       
  • Aetiology and outcome of paediatric cardiopulmonary arrest
    • Authors: Helen Jones; Sally L. Wilmshurst; Cameron Graydon
      Abstract: Publication date: Available online 28 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Helen Jones, Sally L. Wilmshurst, Cameron Graydon
      Paediatric cardiopulmonary arrest is an uncommon event in the general population but is not infrequent in the paediatric hospital setting. This article looks at the causes of arrests in children, the likely outcomes, and the ways in which this can be improved.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.003
       
  • Principles of pressure transducer function and sources of error in
           clinical use
    • Authors: Thomas E.F. Walton; Ming Wilson
      Abstract: Publication date: Available online 28 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Thomas E.F. Walton, Ming Wilson
      The invasive measurement of physiological pressures is a common requirement in anaesthesia and intensive care medicine. From arterial blood pressure to intracranial pressure, these calculated variables give a swift graphical and numerical representation of a patient's current physiological status. This allows us to respond rapidly to conditions outside our preferred parameters and to carefully titrate treatments to target effects. These systems are, however, not infallible. An understanding of the principles of their function will promote appropriate use and an ability to recognize and react to sources of error. This article aims to furnish the reader with this level of understanding in order to inform their academic and clinical practice.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.010
       
  • Transfusion guidelines in children: II
    • Authors: Helen Jones; Katherine Reeve
      Abstract: Publication date: Available online 28 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Helen Jones, Katherine Reeve
      The appropriate avoidance of the use of blood products can reduce the incidence of adverse events. This article presents ways of achieving this goal and introduces the process of the safe administration of blood products where indicated.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.004
       
  • Intraosseous cannulation in children
    • Authors: Victoria J. Bewick
      Abstract: Publication date: Available online 25 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Victoria J. Bewick
      In an emergency situation when intravenous (IV) access cannot be rapidly achieved, the intraosseous (IO) route is recommended in order to infuse medications and fluids. Specifically designed needles make this technique quick, easy and reliable. This article describes the anatomy and physiology relevant to IO cannula insertion as well as indications and contraindications for IO use. The variety of devices and the techniques for their use in the paediatric population are discussed.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.002
       
  • Ethics in clinical trials
    • Authors: Kirsteen A. Jones; Michael Semple
      Abstract: Publication date: Available online 25 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Kirsteen A. Jones, Michael Semple
      Although one of the first pieces of legislation to address ethical issues in clinical trials was drawn up following the findings from the Nuremberg Trials, only in the most recent clinical research have the principles of beneficence, non-maleficence, autonomy and justice been considered and informed consent plays a major role. In the UK, the National Research Ethics Service and the Medicines and Healthcare Products Regulatory Agency require compliance with Good Clinical Practice. Patients are unlikely to participate in, or clinicians consent their patients to, trials where they do not feel safe or protected – data and safety monitoring assess for loss of clinical equipoise thus ensuring the most efficacious treatment is always available. Honesty and trust are crucial and place an obligation on investigators to disseminate even less favourable trial results, with the ultimate aim being partnerships between patients, their families, and those delivering the research which are mutually beneficial and respectful.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.005
       
  • Fluid and electrolyte balance in children
    • Authors: Mark Terris; Peter Crean
      Abstract: Publication date: Available online 25 September 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Mark Terris, Peter Crean
      Safe intravenous fluid prescription in children requires an understanding of certain basic principles to avoid adverse events. Careful consideration needs to be given to both the appropriate rate and composition of the fluids to be administered with frequent re-assessment. In this review we examine the indications for parenteral fluid management; specifically maintenance fluid requirements, correction of any fluid deficit and replacement of ongoing losses. The role of non-osmotic secretion of anti-diuretic hormone (ADH) is discussed and children at particular risk are identified. We review complications associated with intravenous fluid therapy, in particular hyponatraemic encephalopathy and discuss the management of this medical emergency. Other electrolyte abnormalities that may arise are highlighted. Fluid management in children with diabetic ketoacidosis is also reviewed.

      PubDate: 2017-10-08T17:18:53Z
      DOI: 10.1016/j.mpaic.2017.07.009
       
  • 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
       
  • 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
       
  • 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
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 50.19.34.255
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-