Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 447, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 12, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 325, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 190, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
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: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 11)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 430, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 57, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 396, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 488, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 55, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 40, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 266, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 214, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 238, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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Similar Journals
Journal Cover
Anaesthesia & Intensive Care Medicine
Journal Prestige (SJR): 0.138
Number of Followers: 67  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1472-0299 - ISSN (Online) 1878-7584
Published by Elsevier Homepage  [3161 journals]
  • Preoperative evaluation of neurosurgical patients
    • Abstract: Publication date: Available online 23 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Mihaela A. Balint, Smita BapatAbstractNeurosurgery encompasses a wide range of established intracranial and spinal procedures as well as rapidly advancing techniques in areas such as functional neurosurgery, interventional neuroradiology and magnetic resonance imaging (MRI). This article focuses on the required preoperative preparation of neurosurgical patients. Both intracranial and spinal surgery is associated with significant morbidity (22 % and 11 %, respectively). There is an overall estimated 30-day mortality risk of around 0.5% for spinal surgery, rising to 4.8 % for intracranial surgery. The most common complications include: the need for re-intervention, blood transfusion, pneumonia and urinary tract infection. Preoperative assessment must consider the surgical procedure being undertaken, pathology and its presentation, as well as patient related factors that can be optimized prior to surgery. It also allows individualized preoperative risk stratification and shared decision-making, informed consent and appropriate planning of perioperative care. Careful documentation of preoperative neurological status is essential for postoperative assessment and management. A thorough understanding of the impact of surgery and anaesthesia on intracranial physiology is also required. This ensures high quality, safe care and excellent patient experience.
       
  • Clinical approach to comatose patients
    • Abstract: Publication date: Available online 20 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rosie May, Katharine HuntAbstractComa is a state of unarousable unconsciousness and can occur as result of many general medical and neurological conditions. In this article we present a structured approach to the investigation and management of a patient who presents with coma and discuss the importance of identifying the underlying cause in attempting to prevent secondary brain damage, as well as for prognostication.
       
  • Acute management of ischaemic stroke
    • Abstract: Publication date: Available online 19 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Deborah R. Douglas, Valpuri Luoma, Ugan ReddyAbstractAn acute ischaemic stroke (AIS) is a non-specific state of brain injury with neuronal dysfunction that has several pathophysiologic causes and is time critical. More than 70% of cases are due to thrombotic or embolic causes with resultant focal ischaemia and an accompanying neurological deficit. Initial assessment, stabilization and early imaging are important aspects of effective stroke management. Over the last two decades, thrombolysis and mechanical thrombectomy have proven beneficial in reversing neurological deficits and improving functional outcomes. Guidelines now support administration of recombinant tissue plasminogen activator (rt-PA) up to 4.5 hours and extension of thrombectomy windows up to 24 hours after onset of symptoms in a select group of patients. Other important aspects of management include administration of antiplatelet agents (aspirin) within 48 hours, management within a specialist stroke unit, and decompressive hemi-craniectomy for malignant middle cerebral artery (MCA) stroke.
       
  • Self-assessment
    • Abstract: Publication date: Available online 19 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Ion channels, receptors, agonists and antagonists
    • Abstract: Publication date: Available online 19 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Cameron J. WeirAbstractThis article describes the physiology of ion channels and the principal molecular mechanisms responsible for modulating their activity by commonly used drugs in anaesthesia and intensive care. The concept of efficient and selective transport of ions across ‘impermeable’ plasma membranes is introduced, together with the mechanisms influencing electrochemical signalling within cells. The classification and composition of voltage-gated ion channels are described in the context of their contribution to action potential generation in excitable cells. Drug–receptor interaction of the four main classes of receptor, that is, ligand-gated ion channels (in particular Cys-loop channels), G-protein-coupled, enzyme-linked and nuclear receptors, are described together with an overview of the various signal-transduction mechanisms adopted by metabotropic receptors to control cellular function. Finally, the principles of drug–receptor interaction of agonists, antagonists and inverse agonists are discussed in relation to their affinity, efficacy and potency.
       
  • Prion diseases
    • Abstract: Publication date: Available online 19 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Michelle LeemansAbstractThe prion diseases, or transmissible spongiform encephalopathies (TSEs), are a group of neurodegenerative diseases. They are caused by an abnormal form of a naturally occurring cellular protein, known as prion protein. All prion diseases are fatal and without cure. Although all are rare, interest has increased over the last 20 years due to the appearance of a new prion disease called variant Creutzfeldt-Jakob disease. This disease is transmissible via medical devices and blood and therefore has implications for the anaesthetist, especially where blood transfusions and the use of airway devices and fibreoptic equipment are concerned.
       
  • Anaesthesia for neurosurgery
    • Abstract: Publication date: Available online 18 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Selina Ho, Oliver Hambidge, Robert JohnAbstractNeuroanaesthesia is an expanding specialty that requires a good understanding of neurophysiology as well as the pathophysiology of raised intracranial pressure. Neuroanaesthetists need to ensure neurosurgical patients maintain an adequate cerebral perfusion pressure intraoperatively, whist providing optimum operating conditions. To achieve this, a balanced anaesthetic technique preventing hypertensive surges and optimizing cerebral venous drainage by careful patient positioning is important. Knowledge of the therapeutic options available to the anaesthetist for decreasing ICP intraoperatively is essential. As neurosurgery evolves, it provides neuroanaesthetists with new challenges including awake craniotomies, stereotactic neurosurgery and intraoperative MRI.
       
  • Pharmacological and pathological modulation of cerebral physiology
    • Abstract: Publication date: Available online 18 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rosie May, Katharine HuntAbstractHomeostatic mechanisms exist to enable the supply of oxygen and glucose for cerebral metabolism and neuronal function. In health, cerebral autoregulation, neurogenic and metabolic processes ensure that the supply of these nutrients is adequate to meet the metabolic requirements, hence preventing neuronal cell damage. The goals of neuroanaesthesia are to provide optimal operating conditions and provide adequate cerebral blood flow, often in the context of a vulnerable brain which is exposed to the physiological stress of surgical trauma. This article outlines how delivery of anaesthesia and disease processes affecting the brain modulate the mechanisms that regulate cerebral blood flow and metabolism.
       
  • The management of spontaneous primary intracerebral haemorrhage
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher J. TaylorAbstractIntracerebral haemorrhage (ICH) accounts for around 10–20% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with significant acute ICH should be managed in a critical care unit. Treatment entails general supportive care, control of blood pressure and intracranial pressure, prevention of haematoma expansion and, where indicated, neurosurgical intervention. In those patients whose bleed extends into the ventricular system or who have infratentorial bleeds are at increased risk of associated hydrocephalus, rapidly increasing intracranial pressure requiring urgent CSF drainage. The 30-day mortality from intracerebral haemorrhage ranges from 35–52%. Among survivors, the prognosis for functional recovery depends upon the location of haemorrhage, size of the haematoma, level of consciousness, the patient's age, and overall medical condition.
       
  • Anaesthesia for interventional neuroradiology
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sarah J. Muldoon, Ian ApplebyAbstractThe volume and range of procedures undertaken by interventional neuroradiologists continues to expand. They are now treating many conditions previously considered untreatable or only amenable to open surgical techniques. To facilitate the close cooperation required between radiologists and anaesthetists necessary for the successful outcome of these complex and lengthy procedures, it is important for the anaesthetist to have an appreciation of the pathophysiology, potential multisystem effects of the underlying disease, cerebral protection strategies and the potential pitfalls of each procedural technique. Maintaining vigilance during the post-procedural monitoring phase is essential for the early recognition of potential complications, such as bleeding or vessel occlusion, which may warrant further emergency radiological or neurosurgical interventions.
       
  • Applied cerebral physiology
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Pranoy Das, Astri LuomaAbstractThis article reviews cerebral metabolism and blood flow, and the pressure dynamics within the cranial cavity. The brain functions within the confines of the cranial cavity and it is important to understand the dynamics of the parenchyma, cerebrospinal fluid and blood in relation to intracranial pressure (ICP) and metabolic needs. It requires an uninterrupted supply of oxygen and glucose to maintain its basal energy requirements and these are increased during periods of enhanced activity. Cerebral blood flow (CBF) is therefore critical for normal cerebral function. Its control is dictated by local intrinsic metabolic needs as well as extraneous factors such as arterial blood pressure, arterial carbon dioxide and oxygen tension, temperature and neural factors; all of which can be measured to guide therapy.
       
  • Therapeutic hypothermia and acute brain injury
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Jagdish Sokhi, Ugan ReddyAbstractSecondary brain injury has devastating effects on morbidity, mortality and good functional outcomes. Neuroprotection is multimodal, with decades of preclinical and small clinical studies showing the benefits of therapeutic hypothermia. The basic scientific principles have merit, yet large randomized controlled trials fail to show a clear benefit. This article will review the basic science the practical aspects of delivering targeted temperature management and evaluate the evidence behind its use for acute brain injuries. With a lack of high-quality evidence for hypothermia, recent consensus statements are shifting the paradigm away from hypothermia to the maintenance of normothermia and prevention of pyrexia.
       
  • Principles of intraoperative neurophysiological monitoring and anaesthetic
           considerations
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Brett Sanders, Santiago Catania, Astri MV. LuomaAbstractSurgery to the nervous system poses risks to neural structures be that mechanical, haemodynamical, chemical or thermal. The role of intraoperative neurophysiological monitoring (IONM) is to facilitate the assessment of the functional integrity of neural structures and provide a real time alerting system when changes caused by surgically induced insults are detected, with the goal of reducing the risk of postoperative neurological deficits. Furthermore, it is also used as a guidance system to map eloquent areas within the cortex and to identify specific neuronal structures, particularly when landmarks cannot be easily recognized. In this article, we focus on the various neurophysiological modalities used in intraoperative monitoring, their basic principles, indications and the information that they provide. We also examine the anaesthetic considerations and the checklist for the multidisciplinary team should an intraoperative alert be issued.
       
  • Cerebrospinal fluid and its physiology
    • Abstract: Publication date: Available online 12 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rosie May, Ugan ReddyAbstractThis article describes the anatomy and physiology of CSF, and how abnormalities can result in hydrocephalus.
       
  • Tracheal intubation
    • Abstract: Publication date: Available online 29 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Barry McGuire, Kimberley HodgeAbstractTracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a common alternative. Prior to embarking upon intubation, a thorough patient history and examination must be undertaken by the laryngoscopist; equipment must be prepared and checked; a trained assistant present; and an experienced anaesthetist available in case assistance is required. Once the endotracheal tube has been placed, correct positioning must be confirmed via both clinical examination and monitoring, including capnography. Tracheal intubation is a procedure that should only be undertaken by trained operators and is not without risk. It is important to note that it is failure to oxygenate patients rather than failure to intubate that ultimately leads to serious morbidity and mortality. The Difficult Airway Society has produced guidelines on how to manage unanticipated difficulty in tracheal intubation; it is essential that every practitioner trained to intubate patients is familiar with these algorithms and the key principles of safe airway management.
       
  • Perioperative anaphylaxis
    • Abstract: Publication date: Available online 29 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nina Hjelde, Abdul G. LalkhenAbstractAnaphylaxis is defined as a ‘severe life-threatening generalized or systemic hypersensitivity reaction’. Anaphylactic shock is characterized by generalized vasodilation and increased capillary permeability, leading to reduction in cardiac output. The pathophysiology of anaphylaxis can be described as immunologic and non-immunologic. The National Audit Project 6 (NAP 6) has recently investigated perioperative anaphylaxis and this article will outline some key updates from their report. Common triggers includes antibiotics, followed by neuromuscular blocking agents, chlorhexidine and patent blue dye. Patients at high risk of adverse outcomes include the elderly and those with pre-existing cardiopulmonary disease. The diagnosis is clinical and can be confounded by physiological changes commonly experienced after induction or airway manipulation. Key management principles include early administration of intravenous adrenaline, CPR if the systolic blood pressure is
       
  • Pathophysiology of respiratory disease and its significance to anaesthesia
    • Abstract: Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): S Kimber CraigAbstractSignificant changes occur in the respiratory physiology of healthy patients during anaesthesia. In patients with underlying respiratory pathology, the changes in respiratory physiology may lead to additional clinical problems during the conduct of anaesthesia and in the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anaesthetist to account for the potential complications of these conditions and manage the anaesthetic accordingly.
       
  • Critical incidents: the respiratory system
    • Abstract: Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Edward TC. Miles, Tim M. CookAbstractRespiratory complications are expensive, not just in terms of the overall litigation burden faced by anaesthetists but also, and more importantly, the mortality and morbidity burden faced by our patients. Critical incidents arising in the respiratory system can cause rapid deterioration if left unchecked: trauma to airway structures can be debilitating or even life threatening; hypoxaemia may result in damage to other organ systems, most notably the brain. Each patient carries their own risk profile, as well as unique ideas, concerns and expectations of their anaesthetist. An understanding of the potential critical incidents that may befall the respiratory system, a patient-centred approach to discussing these risks, and familiarity with the procedures for mitigating harm are all necessary components of safe, effective practice in anaesthesia.
       
  • Anaesthesia for eye surgery in paediatrics
    • Abstract: Publication date: Available online 26 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Tom Y. Pettigrew, Sarah J. SmithAbstractChildren are rarely able to tolerate being awake for any type of surgery under local anaesthesia, therefore the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may have eye abnormalities as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child's behaviour, co-existing medical issues and the surgical conditions required for the specific procedure. Factors influencing Intraocular pressure may require to be controlled, and anaesthetists should be vigilant for the oculocardiac reflex. Postoperative nausea and vomiting (PONV) is increased in ocular surgery, particularly with strabismus correction. Pain and opioid analgesics can both increase the risk of PONV. In most cases, simple analgesia and the intraoperative use of topical local anaesthesia will provide effective postoperative pain relief.
       
  • Physiology of ageing
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Frances Young, Simon MaguireAbstractThe impact that ageing has on organisms is a complex interaction between the processes of ageing at a cellular, organ and integrated systems level, and the effects of environmental factors such as nutrition, infection and trauma. Recovery from an insult that triggers a pathological response is never complete. The incremental fall in possible performance is part of the progressive diversity in ‘physiology’ that is the true hallmark of ageing. In this article we will outline some of the physiological changes, particularly cardiorespiratory, associated with the ageing process that will be of relevance to anaesthesia.
       
  • Eye signs in anaesthesia and intensive care
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Jhalini Jawaheer, Lona JawaheerAbstractOphthalmology can be unfamiliar territory for the anaesthetist and intensivist. This article describes the signs associated with iatrogenic injury to the eye in the operating theatre and the intensive care unit. Patients are at risk of corneal abrasions, exposure keratopathy and chemosis. The prone patient encounters an additional risk of ischaemic optic neuropathy and acute glaucoma. In the intensive care setting, the intensivist should be alert to signs of ocular infection, for example, conjunctivitis, microbial keratitis and endophthalmitis. In the trauma patient, careful evaluation of the eye is required to rule out sight-threatening conditions such as retrobulbar haemorrhage, globe rupture, orbital fractures and retinal detachment.
       
  • Regional anaesthesia for eye surgery
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Rachel Fulton, Craig UrquhartAbstractMany ophthalmic procedures are conducted under a range of local anaesthetic techniques. These range from topical drops through to sharp needle blocks with local anaesthetic. The most commonly used block is the sub-Tenon block; it provides excellent operating conditions while reducing complications and risks.
       
  • Ocular anatomy and physiology relevant to anaesthesia
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stuart Watson, Genevieve LoweAbstractAn understanding of the anatomy of the orbit is essential for performing regional anaesthesia for ophthalmic surgery. This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles.
       
  • Care of the eye during anaesthesia and intensive care
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): James Small, Emily Robertson, Colin RuncieAbstractThis article describes care of the eye during a period of vulnerability in anaesthesia and intensive care. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries will be covered as well as good practice points and preventative measures pertinent to all anaesthetists and critical care practitioners.
       
  • General anaesthesia for ophthalmic surgery
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Stuart Young, Aravind BasavarajuAbstractThe majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surgery. Therefore adequate preoperative evaluation and preparation will minimize perioperative complications. The goals of general anaesthesia are smooth induction and emergence, with stable intra-ocular pressure (IOP) and akinesia of the globe. These can be achieved with a combination of intravenous and inhalational agents with or without muscle relaxants and opiates. Use of the laryngeal mask airway has the advantage of causing a smaller rise in IOP on insertion and less coughing on emergence. Total intravenous anaesthesia with propofol and remifentanil has the advantages of causing less postoperative nausea and vomiting (PONV), reduced stress response to airway intervention, rapid recovery and smooth emergence. Some eye procedures require special consideration, for example, strabismus and vitreoretinal surgery involves traction of the rectus muscles producing a higher incidence of oculocardiac reflex and PONV. Most ophthalmic surgery produces mild to moderate pain amenable to non-opioid analgesics. Intraoperative topical and regional anaesthesia reduce postoperative pain and opiate requirement. Open globe injury and a full stomach present unique challenges to prevent increase in IOP as well as protecting the airway.
       
  • Anaesthesia in the elderly
    • Abstract: Publication date: Available online 25 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): David J. ChambersAbstractOlder people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty.
       
  • Self-assessment
    • Abstract: Publication date: Available online 24 November 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Management of the airway in intensive care
    • Abstract: Publication date: Available online 25 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Miles Beeny, Arno CrousAbstractAirway management in the intensive care unit (ICU) is largely uneventful; there is a higher incidence of airway difficulties, however, than those encountered in the operating suite. Management of the airway in the ICU presents challenges unique to this environment that must be coped with by a multidisciplinary team that may be less experienced in airway management than clinicians in the operating theatre. The risks associated with this situation, we believe, may be ameliorated by planning and forethought. This article outlines some of the specific difficulties faced by clinicians in ICU and attempts to provide some guidance as to how these may be overcome, or at least abated. Drug and equipment choices are discussed. A suggestion for a difficult airway algorithm for use in the ICU is put forward. The timing of tracheostomy is discussed. Finally, the importance of the team and the human factors that are at play are touched upon.
       
  • Ventilatory support in the intensive care unit
    • Abstract: Publication date: Available online 21 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Eumorfia Kondili, Athanasia Proklou, Aikaterini VaporidiAbstractThis article focuses on the functional features of positive-pressure ventilators, the modes of invasive and non-invasive mechanical ventilation, and the main ventilator settings. It also highlights the potential complications of mechanical ventilation, the basic principles of weaning, and the pathophysiological basis of patient-ventilator dyssynchrony.
       
  • Self-assessment
    • Abstract: Publication date: Available online 19 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Vijayanand Nadella
       
  • Field anaesthesia and critical care equipment used by the British Military
    • Abstract: Publication date: Available online 19 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma L. Watson, Jonathan A. RoundAbstractThis article provides a description and discussion of the key equipment used by the British Defence Medical Services (DMS) to provide anaesthesia and critical care in the field. There is a need to balance equipment clinical capability against its suitability for use in the field. By necessity, military anaesthesia and critical care equipment should be robust, portable, compact, easy to use, easy to maintain and clean, and require minimal consumables.
       
  • Strong ion analysis at the bedside
    • Abstract: Publication date: Available online 18 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nithin Abraham Raju, Ryan Hughes, Matthew J. BrainAbstractQuantitative physicochemical models of human acid–base physiology filled a void between clinical acid–base analysis and general fluid physiology. Established approaches centred on the Henderson–Hasselbalch (HH) equation allow satisfactory bedside exploration of respiratory perturbations, but do not fully elucidate mechanisms of common non-respiratory ‘metabolic’ components. Though useful at the bedside, commonly used ‘rules of thumb’ that classify disturbances based on quantification of bicarbonate relative to CO2 have also fostered a language that often misrepresents bicarbonate physiology. The physicochemical model is frequently perceived as too complex for bedside use, however a set of simplified screening questions based on Stewart's model can be utilized to aid acid-base interpretation. Examples using this approach are included in an online appendix. Emphasis is placed on understanding the consequences of hypoalbuminaemia, volume status, tonicity and chloride derangements as these are common in ICU patients.
       
  • Disinfection, sterilization and disposables
    • Abstract: Publication date: Available online 18 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Anthony J. Wilson, Sandeep NayakAbstractMedical devices are one way by which healthcare-associated infections can be transmitted. Medical equipment can be categorized based on its risk of spreading infection and these categories aid decisions about whether to decontaminate or dispose of a used medical device. Decontamination is the process by which a reusable device is rendered safe for further use through cleaning and either disinfection or sterilization. It is frequently an automated process which usually involves thermal or chemical techniques and is subject to extensive quality control. Most microorganisms are inactivated or destroyed by disinfection but sterilization is required to eliminate resistant organisms and bacterial spores. Single-use medical devices are now commonplace and avoid the need for decontamination altogether.
       
  • Initial assessment and management of trauma encountered in the field
    • Abstract: Publication date: Available online 17 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma Coley, Sarah FaddenAbstractThis article covers the principles of trauma care relating to specific competencies within the military higher training module. The majority of these principles relate to the pre-hospital assessment and management of patients, introducing some of the nuances of military medicine in comparison to civilian practice.
       
  • The poisoned patient
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Nora Gonzalez, Fin O'SullivanAbstractPoisoning is a common reason for admission to the intensive care unit. The majority of patients are due to deliberate self-harm with common poisons; however, there are occasional unusual poisons which require more detailed assessment. Patients are often obtunded or unwilling to co-operate so a knowledge of toxidromes to recognize symptoms that are related to groups of drugs that act on receptors is essential. Management of poisoned patients is generally supportive, including measures to reduce absorption and increase elimination, as well as the use of specific antidotes and techniques to remove poisons.
       
  • Asthma and chronic obstructive pulmonary disease in the intensive care
           unit
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): David Tuxen, Mark HewAbstractThere are many pitfalls in the management of patients with asthma or COPD especially when their condition becomes severe enough to warrant intensive care. Mortality in both groups remains significant. Standard principles of oxygen and drug administration and mechanical ventilation technique used for other critically ill patients can all cause problems in this patient group. Recognition of the presence of airflow obstruction, the potential for dynamic hyperinflation and careful adherence to the principles of therapy specific to this group are required to avoid complications. This article addresses the physiological derangements in airflow obstruction, their treatment consequences and how to avoid the management pitfalls that are important contributors to the morbidity and mortality of both conditions.
       
  • Surgical diathermy and electrical hazards: causes and prevention
    • Abstract: Publication date: Available online 16 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): James H. MacG PalmerAbstractThe hospital environment is both unique and unusual in that electrical equipment is directly applied to the human body. From this application either capacitive or resistive coupling may lead to current flow and harm. Surgical diathermy, patient monitoring and imaging, although universal, are often misunderstood, and many clinicians are ignorant of their principles and hazards. Electrical equipment in hospital therefore has the potential to lead to serious injury or death. This article outlines the basic physics of electricity, in particular the principles behind diathermy, the hazards posed by it and by other devices and the various measures available to reduce the risk of these.
       
  • Chemical casualties – Recognition and management
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Kevin Wu, Fin O'SullivanAbstractPoisoning with chemical agents was once thought to be confined to the battlefield. However, over the past decade there has been an increase in the use of chemical weapon agents and toxic industrial chemicals as weapons of terror. As well as use during conflict, these poisons have been used in other attacks with deadly effects. These agents require particular treatments that fall out with standard medical practice to reduce harm and prevent contamination of medical treatment facilities. The risk of a mass casualty incident with a deliberate or accidental release is a possibility.
       
  • Acute respiratory distress syndrome
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Robert Hart, Euan BlackAbstractAcute respiratory distress syndrome (ARDS) is a devastating clinical condition characterized by poor gas exchange and bilateral interstitial opacification demonstrated on chest imaging. Despite years of research, the mortality associated with ARDS remains high. Early recognition and treatment of the underlying cause, combined with strategies to reduce ventilator-induced lung injury are key to optimising the likelihood of survival. This article will provide an update on the most recent evidence base on clinical practice, including the use of acute severe respiratory failure bundles and extracorporeal techniques to support lung protective ventilation.
       
  • Extracorporeal support of the respiratory system
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Emma L. Hartley, Stuart GillonAbstractIn the last 20 years there have been significant advances in extracorporeal support of the respiratory system. What once was a highly complex intervention, undertaken as a salvage procedure in a handful of patients, has become more wide spread, both in terms of availability and underlying indications. We review the principles of equipment; physiological control of oxygenation and decarboxylation; associated complications; and role in clinical practice. The evidence for extracorporeal life support in this rapidly evolving field of organ support is critiqued.
       
  • Community-acquired pneumonia
    • Abstract: Publication date: Available online 15 October 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Russell AllanAbstractCommunity-acquired pneumonia (CAP) is a common inflammatory process contained within the lung tissue in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response and these patients may require admission to the intensive care unit (ICU). The CURB-65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigations permit pathogen-speciflc antibiotic therapy and provide epidemiological data. Appropriate and timely administration of antibiotics is the mainstay of treatment. Complications include empyema, treatment failure, sepsis, respiratory failure and death.
       
 
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