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Publisher: Elsevier   (Total: 3160 journals)

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Showing 1 - 200 of 3160 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 97, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 428, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 289, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 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: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 175, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, 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: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 32, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, 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: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 11)
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: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 49, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 61, 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: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, 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: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 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: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 414, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 35, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 19)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 49, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 363, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 471, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 43, 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: 6, 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: 11)
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: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 48)
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: 232, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 29, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 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: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, 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: 5, 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: 200, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 207, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)

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Similar Journals
Journal Cover
Anaesthesia & Intensive Care Medicine
Journal Prestige (SJR): 0.138
Number of Followers: 63  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1472-0299
Published by Elsevier Homepage  [3160 journals]
  • Self-assessment
    • Abstract: Publication date: Available online 10 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Crystalloids, colloids, blood products and blood substitutes
    • Abstract: Publication date: Available online 9 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Christopher Naisbitt, K.F.A. Mos, Roop Kishen Understanding the physiology of fluid distribution in the human body is fundamental to good clinical practice in anaesthesia and intensive care. Intravenous fluid therapies have a range of clinical and metabolic consequences and they should be context and patient specific. Inadequate or excessive fluid treatment is harmful to patients. There are numerous trials, both historical and current, investigating best practice in fluid therapy. New paradigms and guidelines are being published, and it is important for clinicians to keep up to date with current practice. There is a continued drive to improve the safety of donor blood and prevent transfusion errors. Knowledge of how blood products are collected, separated and stored is essential to prevent harm to patients through transfusions. The development of blood substitutes is progressing, with NHS trials involving stem cell originated red cells having begun.
       
  • Peripheral and local anaesthetic techniques for paediatric surgery
    • Abstract: Publication date: Available online 9 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Steve Roberts, Katie Misselbrook, Ruth Cowen Peripheral nerve blocks provide intraoperative and postoperative analgesia and are usually used as adjuncts to general anaesthesia in paediatric patients. For children in the UK, most of these blocks are performed under general anaesthesia. In older cooperative children, some are performed awake, providing the correct environment and reassurances are available to minimize stress and anxiety. Peripheral nerve blocks provide good-quality analgesia without the adverse effects associated with systemic medications. Good pain management reduces morbidity and aids patient recovery, resulting in better patient and family satisfaction and earlier discharge. These factors are essential for successful and efficient paediatric surgery. Failure to achieve good pain control is obviously unpleasant, but has also been identified in the occurrence of sleep and behavioural disturbances in children following surgery. Delayed recovery and discharge can have significant disruptive and economic effects on the family and hospital. Despite these benefits, peripheral nerve blocks, like all invasive techniques, are associated with complications and adverse effects. They should only be performed after careful analysis of the risk:benefit ratio. This article discusses a general approach to peripheral nerve blocks in children, along with the benefits of a predominately ultrasound-based approach and the role of peripheral catheters.
       
  • Neuraxial anaesthesia in paediatrics
    • Abstract: Publication date: Available online 7 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Ryan Marcelino, Amod Sawardekar, Santhanam Suresh Neuraxial anaesthesia is a valuable aid in the practice of paediatric anaesthesia. Spinal and epidural blockade are used as either the sole anaesthetic or as an adjunct to general anaesthesia, and often confer significant postoperative analgesia. Caudal epidural anaesthesia is used extensively for lower abdominal, urological and orthopaedic procedures in the setting of outpatient surgery. Lumbar and thoracic epidural infusions via a catheter can provide analgesia for chest and upper abdominal procedures. Major complications related to neuraxial catheter placement are uncommon in paediatric anaesthesia, even though block placement is typically after the patient is anesthetized. The use of the ultrasound for real-time visualization during paediatric neuraxial blocks provides an opportunity for observing final catheter position or confirming successful injection into the epidural space.
       
  • Principles of paediatric anaesthesia
    • Abstract: Publication date: Available online 7 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Judith A. Nolan This article provides an overview of the practical aspects of paediatric anaesthesia, with particular emphasis on airway and fluid management. Common dilemmas that may be encountered during preoperative assessment are highlighted, including the child with asthma, obstructive sleep apnoea and the particularly anxious child. In light of the findings of the fourth National Audit Project (NAP4), strategies for managing the child with the difficult airway are discussed. The rationale for the use of isotonic perioperative fluids is outlined, along with the management of intraoperative blood loss. The increasingly recognized problem of emergence delirium is also discussed.
       
  • Paediatric day-case surgery
    • Abstract: Publication date: Available online 7 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Sarah Heikal, Lowri Bowen, Mark Thomas Paediatric day surgery is common and increasingly more complex surgeries are being carried out on more complex children. The benefits to the child and parent include less disruption to daily routines and fewer psychological and emotional effects than an overnight stay would incur. The use of day-case services improves efficiency and is more cost effective for organizations. To deliver high-quality paediatric day surgery services there are several key components to address. This article discusses the role of preoperative assessment and the need to consider each case individually despite robust inclusion/exclusion criteria. Optimization of preoperative hydration, pain management and prevention of postoperative nausea and vomiting are highlighted as important factors to successful day-case surgery.
       
  • Pain assessment in children
    • Abstract: Publication date: Available online 3 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Katherine Brand, Andrew Al-Rais Acute pain in children can occur following trauma and injury or secondary to medical and surgical intervention. Before acute pain can be effectively treated, it must be accurately assessed. In spite of many years of research to enhance our understanding of pain, the assessment of pain in children continues to be a challenge and is often inconsistent and suboptimal in many organizations. Pain and its perception are multi-factorial, hence an approach to pain assessment and treatment must also be multi-faceted and multidisciplinary. Painful experiences are dynamic, with huge inter- and intra-individual variation; therefore pain assessment tools must be adaptable, reproducible and accurate to accommodate such variation. This article outlines the different tools available for pain assessment in infants and children (excluding neonates).
       
  • Total intravenous anaesthesia in children: a practical guide
    • Abstract: Publication date: Available online 3 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Patrick Cowie, Alistair Baxter, Jon McCormack Total intravenous anaesthesia (TIVA) is increasingly used for maintenance of anaesthesia in both adults and children. This article will discuss topics relevant to administration of TIVA in children – the potential benefits of TIVA, challenges and some clinical examples of its use.
       
  • An update of systemic analgesics in children
    • Abstract: Publication date: Available online 3 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Jennifer A. Wright Effective and safe pain management in children can be complex and challenging. It remains an important goal in order to minimize acute distress, behavioural changes, central sensitization and hyperalgesia. Neonates are particularly susceptible to long-term neurodevelopmental changes due to the neuroplasticity of their immature brains, and adequate analgesia may help ameliorate these changes. The focus of this review is to look at systemic analgesic options available for children, infants and neonates. This review includes a brief description of important pharmacokinetic, pharmacodynamic and pharmacogenomic issues that can influence the effectiveness and safety of these medications, while highlighting the impact organ-immaturity in neonates can have on pain processing and analgesic pharmacology.
       
  • Safe sedation of children for diagnostic and therapeutic procedures
    • Abstract: Publication date: Available online 3 May 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Andrew M. Langdon, Rishi Diwan There is an increasing use of sedation in children requiring imaging and other minor procedures. This article will discuss how sedation can be safely performed. The depth of sedation has been classified into minimal, moderate and deep according to the National Institute for Health and Care Excellence. Amongst others, benefits of sedation include increased parental and child satisfaction, increased cost ben- efits for the hospital and reduced adverse effects of general anaes- thesia such as emergence delirium and postoperative nausea and vomiting. Safe sedation can be used for a wide range of procedures, most commonly for CT and MRI. Others include removing drains, changing burns dressings, simple plastic surgery procedures and endoscopy. Drugs can be used as sole agents or in combination to produce the desired level of sedation appropriate for the procedure. The children must be monitored according to the depth of sedation and personnel should be trained in the management of potential complications.
       
  • Postoperative care and analgesia in vascular surgery
    • Abstract: Publication date: Available online 5 April 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Shaun McMahon, Rachael L. Bird Patients undergoing major vascular surgery are high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key: stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia. Continuation of preoperative risk-reduction strategies including aspirin, beta-blockers and statin therapies are critical, and should be continued in the postoperative period. Maintaining a high index of suspicion for procedure-specific complications is essential in order to reduce morbidity and mortality in these patients.
       
  • Anaesthesia for the ruptured aortic aneurysm
    • Abstract: Publication date: Available online 5 April 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Matthew Cheesman, Andrew Maund The perioperative management of ruptured abdominal aortic aneurysms (RAAA) remains a core anaesthetic competency. Changes such as service centralization, aneurysm screening and the developing role of emergency endovascular aneurysm repair (EVAR) are altering the demands upon anaesthetists. Whereas previously on-site general anaesthesia for resuscitative open aneurysm repair (OAR) was standard, now transfer, choice of surgical technique and options for anaesthetic management may need to be considered. We present the key components of emergency anaesthesia for both OAR and EVAR and describe clinical dilemmas arising at preoperative and intraoperative stages.
       
  • Self-assessment
    • Abstract: Publication date: Available online 28 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Risk modification and preoperative optimization of vascular patients
    • Abstract: Publication date: Available online 22 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Ben A. Goodman, Adam Pichel, Gerard R. Danjoux Major vascular surgery is associated with a high risk of morbidity and mortality. Targeted optimization of organ systems most likely to suffer morbidity should be made prior to elective surgery. Risk modification can reduce both perioperative and long-term complications. This article summarizes currently accepted best practice for risk modification and preoperative optimization prior to vascular surgery.
       
  • Neurological and humoral control of blood pressure
    • Abstract: Publication date: Available online 21 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Soumitra K. Ghosh, Jaideep J. Pandit There is a relationship between arterial blood pressure, cardiac output and vascular resistance described mathematically, that helps us to understand short-term control of blood pressure in terms of a hydraulic system. Arterial baroreceptors are specialized sensors which mediate a rapid response to sudden changes in pressure through interaction with the autonomic nervous system. This in turn influences heart rate, inotropic state and vascular tone, altering distribution of blood between arterial and venous systems, thus compensating for acute changes in total blood volume. Total blood volume is controlled predominantly by the kidney, with the renin–angiotensin–aldosterone system acting as both the ‘sensor’ of blood pressure/volume (via renin release in the juxtaglomerular apparatus) and the ‘effector’ of blood pressure/volume (via aldosterone secretion by the adrenal cortex). Overall control is shared; the baroreceptors being responsible for mediating short-term changes, and renal mechanisms determining the long-term control of blood pressure. These systems have to be adaptable in order to deal with physiological variation in the delivery of blood to tissues from rest to exercise, and with the large shifts in blood volume seen in acute haemorrhage. Pathophysiological changes in these systems lead to maladaptive responses, with systemic hypertension the most commonly seen.
       
  • Anaesthesia for carotid surgery
    • Abstract: Publication date: Available online 21 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Michael Stallard, Indran Raju Carotid endarterectomy (CEA) is a surgical procedure to prevent strokes in patients with atheromatous disease at the carotid bifurcation. The effectiveness of CEA has been established in large clinical trials. Patients should have surgery performed within 2 weeks from the onset of symptoms. This time frame presents challenges to the anaesthetist and surgeon in terms of risk stratification and optimization of patients. Optimization includes blood pressure control and use of antiplatelet and lipid-lowering therapy. CEA can be carried out under general anaesthesia or regional anaesthesia with the advantages and disadvantages of both techniques discussed. Understanding surgical technique and the implications for anaesthesia is important, specifically the use of carotid shunting, eversion technique and patch angioplasty. Cerebral perfusion monitoring can be used during CEA to reduce neurological morbidity and mortality. The gold standard for monitoring remains an awake patient where sensory, motor and higher mental functions can be assessed continuously. Intraoperative and postoperative management may involve haemodynamic and neurological complications such as stroke, cerebral hyperperfusion syndrome, heart failure and myocardial infarction. Compromise to the airway can occur as a result of oedema or haematoma and the latter may require exploration in theatre.
       
  • Anaesthesia for endovascular aneurysm repair
    • Abstract: Publication date: Available online 21 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): John Barrett, Sian Jones A patient with an abdominal aortic aneurysm can have surgical management through either an open or endovascular approach. The use of an endovascular approach has benefits for the patient by being a less invasive approach with initially lower mortality and morbidity and lower lengths of hospital stay, although longer term outcomes match open techniques. The endovascular technique requires more specialist equipment, including stents and imaging equipment. In the UK they are usually performed in specialist hospitals with teams of interventional radiologists, vascular surgeons and anaesthetists working together. Patients presenting for endovascular repair of their abdominal aortic aneurysm can present the anaesthetist with range of complex comorbidities which require specific management and optimization pre-operatively. The intraoperative management of the patient can vary, depending on patient, surgical and anaesthetic factors, from local anaesthetic, regional techniques or general anaesthesia. The postoperative complications are generally minimal, but the patients require lifelong follow up, making the procedure more expensive than an open procedure.
       
  • Self-assessment
    • Abstract: Publication date: Available online 20 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Viyayanand Nadella
       
  • Anaesthesia for vascular surgery on the extremities
    • Abstract: Publication date: Available online 20 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Richard J. Telford Peripheral arterial surgery is challenging, operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.
       
  • Preoperative assessment of patients for major vascular surgery
    • Abstract: Publication date: Available online 19 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): James W. Durrand, Gerard R. Danjoux Effective preoperative evaluation of patients prior to major vascular surgery remains a significant multidisciplinary challenge. Focussed preoperative evaluation targeted to organ systems can mitigate the combined effects of inherently high-risk surgical procedures undertaken in a patient population with well-recognized comorbidity. Careful history and examination, supported by appropriate investigations and specialist input, remains the cornerstone of this process, with risk increasingly quantified by dedicated scoring systems. In addition, the objective assessment of functional capacity is now common in UK units with cardiopulmonary exercise testing widely employed and considered a ‘gold standard’ by many. When employed in a timely manner, complete preoperative assessment allows more informed perioperative decision-making, frank discussion of risk with the patient and effective utilization of critical care resources if required.
       
  • Applied cardiovascular physiology
    • Abstract: Publication date: Available online 19 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Carla Gould, Jon Hopper Maintaining an equilibrium between oxygen supply and demand is a principal function of the cardiovascular system. In times of altered metabolic demand mechanisms exist to maintain the balance between supply and demand. Exercise, haemorrhage and pregnancy all lead to changes in oxygen demand and subsequently modification of cardiac output. During isotonic exercise, metabolic demands of muscle are greatly increased. Sympathetic stimulation and inhibition of the parasympathetic system lead to increases in heart rate and venous return, increasing cardiac output. This allows a proportional increase in blood flow to the exercising muscle. Cardiac output increases throughout pregnancy. In the first and second trimesters this rise is mainly due to an increase in stroke volume, however during the later stages of pregnancy stroke volume reaches a plateau and further increase in cardiac output is mediated by a rising heart rate. In contrast, during haemorrhage, decreased venous return leads to a reduction in cardiac output, with a baroreceptor response due to the drop in arterial blood pressure. The tachycardia and vasoconstriction which follows are compensatory mechanisms in an attempt to preserve blood pressure. The Valsalva manoeuvre illustrates several aspects of reflex control of the cardiovascular system and allows non-invasive assessment and quantification of control mechanisms. Changes in stroke volume during the respiratory cycle can be used to predict fluid responsiveness and can be measured as pulse pressure variation or stroke volume variation.
       
  • Anaesthesia for open abdominal aortic surgery
    • Abstract: Publication date: Available online 19 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alastair Duncan, Adam Pichel The prevalence of abdominal aortic aneurysm (AAA) and the number of patients undergoing aneurysm repair is increasing. The UK has worked tirelessly to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement programme. Reducing death from ruptured aortic aneurysm has been the focus of the national screening programme. Despite the increased prevalence of disease and intervention, the popularity of open repair has diminished since the advent of endovascular repair (EVAR). The short-term benefits of EVAR when compared to open repair are well described; however, the long-term survival benefits, freedom form re-intervention and cost effectiveness of EVAR are not proven. The choice of technique for emergency AAA repair is contentious, with the more traditional approach of open repair being rapidly overtaken by endovascular options. In this article we provide an overview of the evidence supporting the different treatment options, outline current approaches to risk stratification, describe the key physiological changes that occur during open repair and describe an overview of the approach to perioperative management.
       
  • Insertion of a chest drain for pneumothorax
    • Abstract: Publication date: Available online 15 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Bilal Kirmani, Joseph Zacharias The insertion of a chest drain, either using the Seldinger technique or as a cut-down for a wide bore tube, is common and relatively straightforward. An appreciation of the anatomy, procedural technique and potential complications is important. The process is outlined here.
       
  • Complications of regional anaesthesia
    • Abstract: Publication date: Available online 14 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alasdair Taylor, Calum R.K. Grant Complications of regional anaesthesia can be divided into those specific to central neuraxial blockade, those specific to peripheral nerve blockade, and those that pertain to both. Fortunately, severe complications, namely spinal cord damage, vertebral cord haematoma and epidural abscess are rare. Here we have given an overview of these complications, with reference to incidences available following the 3rd National Audit Project of the Royal College of Anaesthetists. A thorough knowledge of anatomy and pharmacology, and a meticulous, unhurried technique are key to reducing the risk of such complications. When considering the use of a regional anaesthetic technique, the risks and benefits for the individual patient should be assessed on a case-by-case basis, and set against the risks and benefits of alternatives.
       
  • Lower limb nerve blocks
    • Abstract: Publication date: Available online 14 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Calum R.K. Grant The proliferation of ultrasound use is changing the approach to regional anaesthesia of the lower limb. Techniques are being developed that provide high-quality postoperative analgesia while minimizing associated motor block that may impair mobilization. Regional anaesthetic techniques also provide significant opioid-sparing benefits (e.g. less sedation, nausea and urinary retention) that are key principles of current enhanced recovery protocols. Ultrasound-guided nerve localization offers several potential advantages when performing femoral, adductor canal, sciatic and ankle blocks; however, neurostimulation remains a useful and widely used aid to lower limb regional anaesthesia practice.
       
  • Systemic toxic effects of local anaesthetics
    • Abstract: Publication date: Available online 13 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Heather N. Sheppard, Ravi Anandampillai Local anaesthetics are widely used in the provision of local/regional anaesthesia and the management of acute and chronic pain. Their mechanism of action temporarily inhibits voltage gated sodium channels in neuronal plasma membranes. Local anaesthetic systemic toxicity (LAST) is a serious yet largely preventable complication that can occur by any of the multiple routes of administration. LAST predominantly affects the central nervous and cardiovascular systems. Awareness of LAST and vigilance during administration of local anaesthetics may help in early recognition and successful management of the toxicity. Intralipid emulsion (ILE) infusions have been successfully used in reversing local anaesthetic-induced cardiotoxicity. Since 2007 in the UK, ILE infusion has been incorporated into the safety guidelines for management of LAST.
       
  • Omics and anaesthesia: pharmacogenomics, proteomics and metabolomics
    • Abstract: Publication date: Available online 8 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Thomas E.F. Walton, Jonathan N. Rajan The inter-individual response to medications and the presence of genetic polymorphisms which impact the safe conduct of anaesthesia and analgesia are of paramount importance to the anaesthetist, intensivist and pain physician. The frequency of these phenomena is not reflected in the attention afforded them in undergraduate or postgraduate curricula. In order to appreciate how these issues may affect our clinical practice, it is crucial to have a working understanding of the concepts that underpin the relevant fields within the collection of disciplines we term the ‘omics’.
       
  • Upper limb nerve blocks
    • Abstract: Publication date: Available online 8 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Pavan Kumar B.C. Raju, James S. Bowness Brachial plexus blockade is used for a variety of upper limb surgical procedures. Ultrasound guidance is generally considered to be the gold-standard technique, although large-scale studies examining efficacy and complications of ultrasound-guided techniques compared with nerve stimulation are still needed. Interscalene block remains the approach of choice for shoulder surgery, although phrenic nerve blockade is common even using low volumes of local anaesthetic. Of the currently available studies comparing the other approaches, there seems to be little difference in efficacy between axillary, supraclavicular and infraclavicular approaches for elbow, forearm and hand surgery when equivalent levels of expertise are used. The major features influencing block choice and performance are discussed.
       
  • Action potential: generation and propagation
    • Abstract: Publication date: Available online 8 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Allan Fletcher In the normal resting state, the plasma membrane of nerve and muscle cells generates a transmembrane electrical potential difference – the intracellular surface of the membrane being approximately 70–80 mV negative to the extracellular surface. This is a result of markedly different concentrations of ions inside and outside the cell, together with different membrane permeabilities to different ions that permits K+ to flow down their concentration gradient from inside to outside the cell. Nerve and muscle cells are ‘excitable’ because they can react to external stimuli by generating an extremely rapid change in transmembrane electrical potential difference known as the action potential. This comprises an initial explosive increase in membrane Na+ permeability that allows these ions to flood down their concentration gradient into the cell, thereby depolarizing the membrane such that the potential difference is transiently reversed to a positive value. However, in nerve and skeletal muscle this lasts for only a millisecond, at which time the membrane potential is just as rapidly restored to its resting negative value (repolarization). These events are controlled by the brief opening and closing of voltage-activated sodium and potassium channels in the membrane. The key features of the action potential are that it is: (i) an all-or-none event, rather than a graded response; (ii) it is self-propagating, such that the wave of depolarization travels rapidly along the plasma membrane; and (iii) it is transient, such that membrane excitability is quickly restored. These features of the action potential allow rapid transfer of information along nerve axons in the nervous system.
       
  • Practical aspects of ultrasound-guided regional anaesthesia
    • Abstract: Publication date: Available online 8 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Pavan Kumar BC. Raju, Calum RK. Grant Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). These include a more accurate understanding of individual patient anatomy, identification of needle tip position and the ability to assess local anaesthetic spread in relation to a target nerve. An understanding of the basic principles and commonly used terminologies of ultrasound scanning is a fundamental requirement when using this technology. The aim of this article is to outline these basic principles and explain the practical aspects of performing nerve blocks, using ultrasound, in order to achieve quick, safe and effective block performance with minimal procedural discomfort for the patient.
       
  • Peripheral nerve catheter techniques
    • Abstract: Publication date: Available online 7 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Ayman H.M. Mustafa Peripheral nerve catheters (PNC) or perineural catheters are used synonymously to describe placing a catheter in close proximity to nerve plexuses or individual nerves for the provision of continuous pain relief. The indications of PNCs extend beyond upper and lower extremity orthopaedic surgery to perioperative analgesia in patients undergoing a wide range of surgical procedures (e.g. abdominal, vascular, thoracic, breast and trauma surgeries). PNC use can facilitate early mobilization after surgery by providing high quality analgesia that in turn leads to reduced opioid consumption and associated opioid related side effects. Perioperative PNC analgesia can result in reduced length of in-hospital stay and improved rates of patient satisfaction. Insertion of peripheral nerve catheters can be done by either anaesthetist or surgeon. Long term benefits are still to be ascertained. Risks are similar to peripheral nerve block although catheter dislodgement remains a specific problem.
       
  • Nerve cell function and synaptic mechanisms
    • Abstract: Publication date: Available online 7 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Allan Fletcher Nerve cells (neurones) are ‘excitable’ cells that can transduce a variety of stimuli into electrical signals, continuously sending information about the external and internal environment (in the form of sequences of action potentials) to the central nervous system (CNS). Interneurones in the CNS integrate this information and send signals along output (efferent) neurones to various parts of the body for the appropriate actions to be taken in response to environmental changes. Networks of neurones have been arbitrarily classified into various nervous systems that gather and transmit sensory information and control skeletal muscle function and autonomic function, etc. The junctions between neurones (synapses) are either electrical or chemical. The former permit the direct transfer of electrical current between cells, whereas the latter utilize chemical signalling molecules (neurotransmitters) to transfer information between cells. Neurotransmitters are mainly amino acids, amines or peptides (although other molecules such as purines and nitric oxide are utilized by some cells), and can be excitatory or inhibitory. Individual neurones within the CNS may receive synaptic inputs from thousands of other neurones. Therefore, each neurone ‘integrates’ this vast complexity of inputs and responds accordingly (either by remaining silent or firing action potentials to other neurones). Adaptations in the function and structure of chemical synapses in particular (synaptic plasticity) are thought to underlie the mechanisms mediating cognitive functions (learning and memory).
       
  • Intravenous regional anaesthesia
    • Abstract: Publication date: Available online 7 March 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Alastair J.M. Baird, Colin B. Donald Intravenous regional anaesthesia, or Bier's block, is a useful and safe technique for anaesthetizing distal limbs for short surgical procedures. It is most commonly used for reduction of forearm fractures within the emergency department and can be a useful method of providing anaesthesia in patients who may be unsuitable for a general anaesthetic, or when skills or equipment for other forms of regional anaesthesia are unavailable. When performed as recommended it has a proven safety record.
       
 
 
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