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Publisher: Elsevier   (Total: 3042 journals)

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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 17, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 327, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 205, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 20, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 40, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 48, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
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: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 341, 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: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 309, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 402, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 36, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 34, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 55, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 24, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 157, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 151, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Anaesthesia & Intensive Care Medicine
  [SJR: 0.124]   [H-I: 9]   [55 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1472-0299
   Published by Elsevier Homepage  [3042 journals]
  • Self-assessment
    • Authors: Vijayanand Nadella
      Pages: 276 - 277
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.001
      Issue No: Vol. 18, No. 5 (2017)
       
  • Self-assessment
    • Authors: Vijayanand Nadella
      First page: 161
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Vijayanand Nadella


      PubDate: 2017-06-13T19:01:17Z
      DOI: 10.1016/j.mpaic.2017.01.001
      Issue No: Vol. 18, No. 3 (2017)
       
  • Mathematical concepts
    • Authors: Ming Wilson
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Ming Wilson
      Some concepts in anaesthesia can be explained by exponentials, logarithms, differentiation and integration. The aim of this article is to discuss these mathematical principles and demonstrate their importance in clinical anaesthesia.

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

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

      PubDate: 2017-06-13T19:01:17Z
      DOI: 10.1016/j.mpaic.2017.04.005
       
  • Mechanics (including force, mass, and acceleration)
    • Authors: David Williams
      Abstract: Publication date: Available online 9 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David Williams
      A knowledge of classical (Newtonian) mechanics is fundamental to understanding anaesthetic equipment and the world around us. This article introduces essential concepts and illustrates them with practical examples. Topics include: Newton’s Laws of Motion; instantaneous and average quantities; the relationships between distance, speed, displacement, velocity and acceleration; gravity, mass and weight; inertia and momentum; energy and power; and translational and rotational motion.

      PubDate: 2017-06-13T19:01:17Z
      DOI: 10.1016/j.mpaic.2017.04.012
       
  • Basic measurement concepts
    • Authors: Gary Thomas; Elana Owen
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Gary Thomas, Elana Owen
      Precise measurement of physiological parameters during anaesthesia is vital, and enables clinicians to deliver safe and appropriate care to patients. Monitoring devices are essential tools in the clinical environment, and accurate records of the measurements provided by these monitors must be kept. The physical parameter to be measured is known as a measurand. Examples of measurands in clinical practice include temperature, voltage and pressure. In the process of measurement, a measurand should be quantitatively compared with a predefined standard. The fundamental components of a basic measurement system consist of a sensor, signal, display at a human interface and a feedback loop. The signal or surrogate marker of a measurand is often processed before display. It is important that the output of a measurement system accurately reflects the value of the measurand. Challenges presented by measurement systems involve the maintenance of precision and accuracy. The input relative to output of a transducer is ideally linear in nature but is subject to hysteresis and drift making regular calibration essential. Outputs of measuring devices will also depend on their ability to respond to static or dynamic change. The readings obtained from measurement devices are also subject to human error.

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

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.007
       
  • Processing, storage and display of physiological measurements
    • Authors: Thomas E.F. Walton; Lucinda A. Hardy
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Thomas E.F. Walton, Lucinda A. Hardy
      Modern anaesthesia demands the monitoring of many biological variables. It is no longer sufficient to be satisfied by a patient of good colour with a temporal pulse of reasonable character, volume and rate, though in times of power loss and technological malfunction these are skills that may still be relied upon! The journey of a biological variable from patient to monitor requires several distinct processes, often imagined within a singular ‘black box’: (i) detection; (ii) transduction; (iii) processing; (iv) display; (v) storage. The aim of this article is to examine each of these elements in turn, to inspect the ways in which different biological variables require distinct handling techniques and to give running examples to portray each step in a way applicable to daily practice.

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.010
       
  • Mechanisms of action of general anaesthetic drugs
    • Authors: David G. Lambert
      Abstract: Publication date: Available online 7 June 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): David G. Lambert
      Based on the diverse array of anaesthetic structures, a single anaesthetic target site seems unlikely. With the knowledge that anaesthesia likely results from central nervous system depression, it can be hypothesized that anaesthesia results from either enhanced inhibitory transmission or reduced excitatory transmission. Two main targets have been extensively described: GABAA receptors and N-methyl-d-aspartate (NMDA) glutamate receptors. On γ-aminobutyric acid (GABA) binding to GABAA receptors, an influx of Cl− results to produce hyperpolarization. With the exception of ketamine, xenon and nitrous oxide, all anaesthetic agents potentiate GABA-mediated conductance. On binding of the main excitatory transmitter glutamate, NMDA receptors gate an influx of Ca2+ and Na+. Ketamine, xenon and nitrous oxide inhibit this ion movement to depress excitatory transmission.

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

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

      PubDate: 2017-06-08T18:38:57Z
      DOI: 10.1016/j.mpaic.2017.04.006
       
  • Cervical spine radiology
    • Authors: Sina Kafiabadi; Prem Rangi
      Abstract: Publication date: Available online 9 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Sina Kafiabadi, Prem Rangi
      Plain radiographs continue to play an important role in the assessment of the cervical spine, despite an ever-increasing uptake of cross sectional imaging. They are widely available and utilized in the setting of trauma to assess for cervical spine injury and stability as an integral part of the trauma series. Furthermore they can provide vital information such as dynamic stability in patients with underlying rheumatological conditions, most importantly rheumatoid arthritis. A systematic approach in analysing cervical spine radiographs can be used to glean important information regarding any underlying injury or instability, initiating further steps in the patient's management and crucially allowing the anaesthetist to take precautions in airway management. We outline some of the most important principles of reviewing such radiographs in the adult population in this article and also aim to outline some of the common pitfalls and limitations of assessing such studies in common practice. Finally we briefly review NICE guidelines on the imaging of cervical spine trauma.

      PubDate: 2017-05-14T16:10:17Z
      DOI: 10.1016/j.mpaic.2017.03.008
       
  • Cervical spine disease and anaesthesia
    • Authors: Robin Kumar; Christopher Taylor
      Abstract: Publication date: Available online 9 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Robin Kumar, Christopher Taylor
      Surgery on the cervical spine is commonly performed to relieve compression of the spinal cord (myelopathy), a nerve root (radiculopathy) or to provide bony stabilization to prevent secondary neurological injury. The pathological causes of myelopathy and radiculopathy are a common consequence of osteoarthritis or less commonly due to disc herniation, tumours, trauma, infection and multisystem disease, and in some conditions as a result of their associated pathologically or surgically induced instability. Successful anaesthetic management should involve a meticulous preoperative assessment of the patient's airway, a systemic review especially in patients with comorbidities and multisystem disease, and attention to their medication and analgesic requirements. Preoperative discussion with the surgical team allows planning of airway management, patient positioning, cardiovascular support (in cases with the potential for significant blood loss), the availability of appropriate blood products and monitoring, postoperative pain management and ward destination.

      PubDate: 2017-05-14T16:10:17Z
      DOI: 10.1016/j.mpaic.2017.04.002
       
  • Extremes of barometric pressure
    • Authors: Jane E. Risdall; David P. Gradwell
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Jane E. Risdall, David P. Gradwell
      Ascent to elevated altitude, commonly achieved through flight, by climbing or by residence in highland regions, exposes the individual to reduced ambient pressure. Although there are physical manifestations of this exposure as a consequence of Boyle’s law, the primary physiological challenge is of hypobaric hypoxia. The acute physiological and longer-term adaptive responses of the cardiovascular, respiratory, haematological and neurological systems to altitude are described, together with an outline of the presentation and management of acute mountain sickness, high-altitude pulmonary oedema and high-altitude cerebral oedema. Whilst many millions experience modest exposure to altitude as a result of flight in pressurized aircraft, fewer individuals are exposed to increased ambient pressure. The pressure changes during diving and hyperbaric exposures result in greater changes in gas load and gas toxicity. Physiological effects include the consequences of increased work of breathing and redistribution of circulating volume. Neurological manifestations may be the direct result of pressure or a consequence of gas toxicity at depth. Increased tissue gas loads may result in decompression illness on return to surface or subsequent ascent in flight.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.04.001
       
  • The cell membrane and receptors
    • Authors: Allan Fletcher
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Allan Fletcher
      The plasma membrane forms the interface between the cell and its environment. It is composed essentially of a phospholipid matrix and many different types of protein molecules which may be embedded within the matrix (integral proteins) or more loosely associated with the cytoplasmic ‘face’ of the membrane (peripheral proteins). The passage of essential ions and molecules across the membrane is controlled by integral proteins acting as channels or transporters. Intercellular communication is mediated by protein receptors, which are activated by signalling molecules such as hormones and neurotransmitters. Physical contact between the cell and its environment (and between cells) is mediated by membrane adhesion proteins. The plasma membrane is a highly dynamic structure in terms of molecular composition and topological configuration. The linkage of the internal cytoskeleton to the plasma membrane (via peripheral and integral proteins) expedites cellular shape changes or amoeboid motion of some types of cell. The process of endocytosis enables the cell to internalize small volumes of extracellular fluid (pinocytosis) by invagination and formation of intracellular vesicles or to engulf entire cells by phagocytosis. Secretion of molecules, such as hormones, is accomplished by fusion of intracellular vesicles with the plasma membrane. This mechanism of exocytosis is mediated by another type of protein: the SNARE proteins.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.005
       
  • Capillary dynamics and the interstitial fluid–lymphatic system
    • Authors: Marina Sawdon; Emrys Kirkman
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Marina Sawdon, Emrys Kirkman
      The capillaries are the ‘business end’ of the circulatory system, where materials exchange between the plasma and tissues. Water-soluble molecules can diffuse through pores in the capillaries, and a Gibbs–Donnan equilibrium exists between the plasma and interstitium. There are several types of capillaries, which vary in their anatomical integrity and permeability. There is also a bulk flow of fluids between the plasma and interstitium, described by the Starling forces. Originally, these forces were thought to cause fluids to leave the capillaries at the arteriolar end and return at the venular end; the role of the lymphatics was to provide an ‘overflow’ mechanism due to protein leakage out of the capillaries. More recent work indicates that this concept needs modification. Lymph flow and interstitial colloidal osmotic pressure are now known to be greater than first thought, and the interstitium has a slightly negative hydrostatic pressure. It is now believed that filtration takes place along most of the capillary, and the lymphatic system plays a more important role in maintaining plasma–interstitium equilibrium and preventing oedema. The system acts as a ‘closed’ one in that the changes in fluid formation (e.g. following haemorrhage or cardiac failure) are self-limiting. However, in some circulations (e.g. those to the kidneys, glands and the gut), net fluid production or absorption is required. This requirement is fulfilled by an independence from the Starling forces, the systems behaving as ‘open’ ones.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.04.003
       
  • Postoperative care of neurosurgical patients: general principles
    • Authors: Gahan Bose; Astri M.V. Luoma
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Gahan Bose, Astri M.V. Luoma
      The primary aim of care immediately after neurosurgery is to detect and prevent neurological deterioration while supporting systemic and neurological homoeostasis. Surgical-, anaesthetic- or disease- related factors may contribute to a slow return or failure to regain a patient's preoperative status. A period of specific monitoring and observation by nursing and medical staff accustomed to neurosurgical and neurocritical care procedures should be planned for the immediate postoperative period. In many neurosurgical centres the period of postoperative observation may be relatively short (e.g. limited uneventful craniotomies); however, if complicating factors such as cerebral oedema, intracranial haemorrhage, seizures or significant premorbid conditions are present, a period of higher dependency care over several days may be anticipated. In common with all postoperative care safe management of the airway, weaning of ventilatory support, control of circulation and fluid balance, feeding, sedation and analgesia are the mainstays of care. Meticulous attention to each of these is essential in the post neurosurgical patient as poor management can profoundly affect neurological outcome. Thus a robust perioperative plan is mandatory for management of the airway, control of blood pressure, and to ensure continuation of preoperative medication. Furthermore, the plan may entail elective creation of tracheostomy and percutaneous endoscopic gastrostomy. The early postoperative neurosurgical patient continues to require a high degree of clinical vigilance.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.004
       
  • Neuromuscular blocking agents and reversal agents
    • Authors: Khorat Farooq; Jennifer M. Hunter
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Khorat Farooq, Jennifer M. Hunter
      The neuromuscular junction consists of the motor nerve terminal, the synaptic cleft and post-synaptic nicotinic receptors on the motor end-plate of striated muscle. Neuromuscular blocking drugs are categorized into depolarizing and non-depolarizing agents. They are structurally related to acetylcholine (ACh), containing at least one positively charged quaternary ammonium radical that binds to the nicotinic receptor. Depolarizing agents (e.g. suxamethonium) act as agonists like ACh at the nicotinic receptor, but cause a more prolonged depolarization of the motor end-plate, thus rendering the ion channel insensitive to further action potentials. Non-depolarizing agents, in contrast, compete directly with ACh for nicotinic receptor binding sites and prevent neurotransmitter–receptor binding. These are either benzylisoquinoliniums (e.g. atracurium) or aminosteroids (e.g. rocuronium). Once recovery has commenced, neuromuscular block can be reversed with anticholinesterases (e.g. neostigmine). In contrast, the novel cyclodextrin sugammadex can be used to reverse any degree of neuromuscular block produced by rocuronium or vecuronium.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.007
       
  • Malignant hyperthermia
    • Authors: Philip Hopkins
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Philip M. Hopkins
      Malignant hyperthermia (MH) is a pharmacogenetic disorder. Indeed, it was among the first group of pharmacogenetic conditions reviewed in the anaesthetic literature. Most patients who are susceptible to MH have no overt manifestations of the condition until they are exposed to the triggering drugs, which comprise the potent inhalational anaesthetics and suxamethonium. There is currently no valid population screening test for MH and the key to avoiding mortality or chronic morbidity rests with anaesthetists recognizing the early features of a developing MH reaction and then intervening appropriately. There are no clinical pathognomonic features of MH but an understanding of the cellular and systemic events underlying the reaction is most useful in making the provisional diagnosis. This article will focus on these pathophysiological mechanisms and the rationale for published management guidelines. As MH is fundamentally a disorder of skeletal muscle calcium regulation it is necessary first to summarize the physiology of skeletal muscle calcium release and reuptake.

      PubDate: 2017-05-09T15:32:12Z
       
  • Monitoring techniques; neuromuscular blockade and depth of anaesthesia
    • Authors: Alexander S. Wycherley; Jane L. Bembridge
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Alexander S. Wycherley, Jane L. Bembridge
      This article outlines the physical principles underlying peripheral nerve stimulation and depth of anaesthesia monitoring in relation to anaesthesia. The patterns of nerve stimulation most commonly used in clinical practice are described including train-of-four, double burst stimulation and tetanic stimulation, as well as methods used to measure motor response. The key technologies currently used to monitor level of consciousness during anaesthesia are also described, namely methods based on electroencephalography and stimulus evoked potentials, including limitations of their use. Published clinical guidelines on the use of both nerve stimulators and level of consciousness monitors are also discussed.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.003
       
  • Neuromuscular disorders: relevance to anaesthesia and intensive care
    • Authors: Joanna Roberts; Ugan Reddy
      Abstract: Publication date: Available online 8 May 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Joanna Roberts, Ugan Reddy
      Neuromuscular diseases are relatively rare but it is important for both anaesthetists and intensivists to have a working knowledge of the common diseases, as they may complicate general anaesthesia and result in neurogenic respiratory failure. The most common neurological condition seen in the intensive care unit is that of critical illness neuropathy; this subject is covered elsewhere in the journal. The diseases most commonly encountered in general anaesthetic practice include motor neurone disease, Guillain-Barré syndrome, botulism, myasthenia gravis and the muscular dystrophies.

      PubDate: 2017-05-09T15:32:12Z
      DOI: 10.1016/j.mpaic.2017.03.009
       
  • Neuromonitoring
    • Authors: Malcolm E. Smith; Martin Smith
      Abstract: Publication date: Available online 7 April 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Malcolm E. Smith, Martin Smith
      Management of acute brain injury is based on a central concept that prevention of secondary hypoxic/ischaemic injury is associated with improved outcomes. While clinical assessment of neurological state remains fundamental to neuromonitoring, several techniques are available for global and regional brain monitoring that provide assessment of cerebral perfusion, oxygenation and metabolic status, and early warning of impending brain hypoxia/ischaemia. Developments in multimodality monitoring have enabled an individually tailored approach to patient management in which treatment decisions are guided by monitored changes in physiological variables rather than pre-defined, generic thresholds. Any impact of monitor-guided therapy on outcomes is entirely dependent on the threshold to initiative intervention and subsequent management in response to change in a particular monitored variable, and these remain undefined in many circumstances. This review describes current neuromonitoring techniques used during the critical care management of acute brain injury.

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.003
       
  • Ear, nose and throat emergencies
    • Authors: Dmitrijs Sokolovs; Ker Wei Tan
      Abstract: Publication date: Available online 2 March 2017
      Source:Anaesthesia & Intensive Care Medicine
      Author(s): Dmitrijs Sokolovs, Ker Wei Tan
      Airway emergencies comprise a diverse group of conditions, which affect upper and lower airways, and have potential for rapid deterioration and lethal outcome unless managed promptly and efficiently. The latter depends on individual skills and effective interaction between anaesthetists, ENT surgeons and other members of the team.

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

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

      PubDate: 2017-03-06T16:06:32Z
      DOI: 10.1016/j.mpaic.2017.01.010
       
 
 
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