Anaesthesia & intensive care medicine RSS feed: Current Issue. Anaesthesia and Intensive Care Medicine , an invaluable source of up-to-date information, with the curriculum of both the Primary and Final FRCA examinations covered over a three-year cycle. Published monthly this ever-updating text book will be an invaluable source for both trainee and experienced anaesthetists. The enthusiastic editorial board, under the guidance of two eminent and experienced series editors, ensures Anaesthesia and Intensive Care Medicine covers all the key topics in a comprehensive and authoritative manner. Articles now include learning objectives and eash issue features MCQs, facilitating self-directed learning and enabling readers at all levels to test their knowledge. Each issue is divided between basic scientific and clinical sections. The basic science articles include anatomy, physiology, pharmacology, physics and clinical measurement, while the clinical sections cover anaesthetic agents and techniques, assessment and perioperative management. Further sections cover audit, trials, statistics, ethical and legal medicine, and the management of acute and chronic pain. http://www.anaesthesiajournal.co.uk/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Anaesthesia & intensive care medicine1472-0299132February 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.anaesthesiajournal.co.uk/article/PIIS1472029912000148/abstract?rss=yesContents10.1016/S1472-0299(12)00014-8Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XOFCOFChttp://www.anaesthesiajournal.co.uk/article/PIIS1472029912000161/abstract?rss=yesEditorial Board10.1016/S1472-0299(12)00016-1Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-Xiihttp://www.anaesthesiajournal.co.uk/article/PIIS1472029911002712/abstract?rss=yesAbstract: Patients with gastrointestinal disease will present with a range of nutritional, fluid and electrolyte disturbances. This article will discuss how to recognize these problems and try to minimize their impact on recovery. A growing body of evidence shows that adoption of a package of care known collectively as enhanced recovery significantly reduces postoperative morbidity and reduces length of hospital stay. For anaesthetists the changes involve analgesic regimens and perioperative fluid and nutrition management. This evidence has been brought together in the national Enhanced Recovery After Surgery Programme and has been introduced to many hospitals for elective bowel surgery patients. The principles of the programme will be discussed. Aspects of it can be applied to many other surgical groups.Anaesthesia for gastrointestinal surgeryRhys Davies, Ingrid Wilkins10.1016/j.mpaic.2011.11.008Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XClinical assessment3942http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002773/abstract?rss=yesAbstract: Liver disease has a high prevalence. Patients with advanced liver disease have poor outcome after surgery. Prognostic scoring systems help to identify those at high risk. Chronic liver disease is associated with typical extra-hepatic manifestations, resulting from failure to clear endogenous vasodilators, splanchnic vasodilation, high cardiac output and decreased central blood volume. Complications include hepatorenal syndrome, hepatopulmonary syndrome and porto-pulmonary hypertension. In fulminant liver failure, cerebral oedema is a prominent feature. Without liver transplantation, prognosis is dismal. Appreciation of the multi-system sequelae of liver disease is a prerequisite to appropriate management.Clinical aspects of hepatic diseaseBoon Hun Yong, Karl K. Young10.1016/j.mpaic.2011.11.012Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XClinical assessment4345http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002761/abstract?rss=yesAbstract: Laboratory tests of liver function are among most commonly ordered blood tests. However, interpretation of parameters should be based not only on measuring the metabolic and synthetic function of the liver, but also parameters which reflect liver injury. Clinical and laboratory assessment of liver function help to identify causes of liver failure, monitor clinical deterioration and prognosis, and determine treatment options including liver transplantation.Laboratory tests in hepatic failureFrances Lui10.1016/j.mpaic.2011.11.011Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XClinical assessment4647http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002670/abstract?rss=yesAbstract: Minimally invasive surgery is commonly performed because of various advantages such as reduced postoperative pain, faster recovery, and reduced postoperative pulmonary complications. However, anaesthesia for laparoscopy can be difficult and potentially hazardous in long, complex surgical procedures and in sick patients. Establishment of CO2 pneumoperitoneum produces adverse pathophysiological changes due to increased intra-abdominal pressure and hypercapnia, and these are further altered by postural changes. Laparoscopy is also associated with potential complications such as extraperitoneal gas insufflation and pneumothorax. It is important for the anaesthetist to understand the advantages and potential risks. General anaesthesia with endotracheal intubation is the most common anaesthetic technique, but supraglottic airway devices can sometimes be used. Neuroaxial anaesthesia has been used in some laparoscopic procedures as the sole anaesthetic technique. This article will focus on the pathophysiological changes caused by CO2 pneumoperitoneum, the anaesthetic management for patients undergoing laparoscopy, and potential complications.Anaesthesia and minimally invasive surgeryMichael G. Irwin, Stanley S.C. Wong10.1016/j.mpaic.2011.11.004Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XClinical assessment4851http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002682/abstract?rss=yesAbstract: The liver is the second-largest organ in the human body. Traditionally, the anatomy of the liver has been described on the basis of its external appearance/gross anatomy. However, with the increase in surgical procedures, for example resection and transplant, the need for a more functional description of the liver based on its vascular and biliary architecture evolved. Different models of functional anatomy of the liver have been described in the literature in the past, but Couinaud’s model of functional anatomy of the liver is the most popular. The liver has dual vascular supply, with most of its supply coming from the portal vein and the remainder through the hepatic artery. In this article, we outline the functional anatomy of the liver along with its blood supply.Functional anatomy and blood supply of the liverVikramjit Mitra, Jane Metcalf10.1016/j.mpaic.2011.11.005Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPhysiology5253http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002694/abstract?rss=yesAbstract: The liver is one of the most important organs in the body and serves a variety of important functions including metabolic, vascular, immunological, secretory and excretory functions. It plays a key role in the carbohydrate, protein and fat metabolism in the human body. In this article, we outline a brief overview of the metabolic functions.Metabolic functions of the liverVikramjit Mitra, Jane Metcalf10.1016/j.mpaic.2011.11.006Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPhysiology5455http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002657/abstract?rss=yesAbstract: Food is divided into digestible portions in the mouth and swallowed – a complex reflex process involving several cranial nerves. The stomach homogenizes food, begins digestion and regulates the rate at which food enters the duodenum. Pancreatic juices containing powerful digesting enzymes are added and digestion is completed in the small intestine. The large bowel dehydrates the gastrointestinal contents.The mouth, stomach and intestinesIain Campbell10.1016/j.mpaic.2011.11.002Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPhysiology5658http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002669/abstract?rss=yesAbstract: The gastrointestinal tract is composed of smooth muscle arranged in two layers: longitudinal and circular. Although its activity is influenced by the autonomic nervous system, it is mainly under local reflex control mediated by an enteric nervous system and local hormones. The motility of the gastrointestinal tract has several different well-defined patterns. Its function is to move the gastrointestinal contents through the various phases of homogenization (mixing), digestion, absorption and elimination.Gut motility and its controlIain Campbell10.1016/j.mpaic.2011.11.003Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPhysiology5961http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002645/abstract?rss=yesAbstract: Carbohydrates, mostly as starch, are digested by salivary and pancreatic amylases to di-, tri- and oligosaccharides, then to monosaccharides by saccharidases on the wall of the small intestine, following which they are absorbed. Proteins are absorbed as amino acids and small peptides that are broken down further, in the cell, to amino acids. Monosaccharides and amino acids pass to the liver via the portal vein. Fats are digested and absorbed as free fatty acids and glycerides and are then mostly reconstituted to triglycerides in the mucosal cells of the small intestine. They combine with phospholipids and a protein to form chylomicrons, which pass via the lymphatics and the thoracic duct into the general circulation. Fatty acids are released in the tissues and are then either re-esterified and stored as triglycerides in adipose tissue or oxidized for energy. Water is absorbed passively, along the osmotic gradient, secondary to the active absorption of sodium ions.Digestion and absorptionIain Campbell10.1016/j.mpaic.2011.11.001Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPhysiology6263http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002736/abstract?rss=yesAbstract: Sympathomimetic agents are commonly encountered in anaesthetic and critical care settings. Some only act on autonomic nervous system reflexes, whilst others affect higher mental function – thus these agents are used frequently in the clinical setting, as well as being drugs of abuse (e.g. the amphetamines). Competition for various metabolic and transport processes can lead to dangerous drug interactions, with sympathetic nervous system overactivity being the major consequence leading to morbidity. They are an important group of drugs and a detailed understanding of their pharmacology is vital to the safe practice of anaesthesia and critical care medicine.Respiratory stimulants also have their place in modern medical treatment. Doxapram and the methylxanthines are used clinically as respiratory stimulants in both adults and infants.Central nervous system stimulants: basic pharmacology and relevance to anaesthesia and critical careNicholas Crutchley, Simon P. Young10.1016/j.mpaic.2011.11.010Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPharmacology6466http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002724/abstract?rss=yesAbstract: Gastric disorders have clinical implications in both anaesthesia and critical care medicine. Aspiration of acidic gastric contents in the perioperative setting is linked to pneumonitis and later development of pneumonia. Pharmacological strategies to minimize this risk include histamine-2 receptor antagonists, sucralfate, proton pump inhibitors and sodium citrate. Use of gastric acid-suppressing therapy is widespread in critical care. The aim is to reduce the incidence of stress-related mucosal bleeding. Intestinal failure is common in critical illness. Medications that decrease gastric motility and contribute to ileus, include opioid analgesics, catecholamines and α2-adrenoceptor antagonists. Current pharmacological strategies for increasing gastric motility include the use of metoclopramide and erythromycin either alone or in combination. Limited efficacy has been demonstrated with these medications. A range of further medications, with different drug targets, are being investigated as alternatives. These include motilin agonists, peripherally acting opioid receptor antagonists, cholecystokinin antagonists, 5-HT4 antagonists and cholinesterase inhibitors.Gastric disorders: modifications of gastric content, antacids and drugs influencing gastric secretions and motilityDaniel H.R. O’Neil, Anton Leonard10.1016/j.mpaic.2011.11.009Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPharmacology6770http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002700/abstract?rss=yesAbstract: The liver is a major organ with multiple functions. Many drugs are metabolized by the liver during phase 1 and 2 reactions which include complex processes involving cytochrome P450. Additionally, drugs can also modify how the liver functions and cause dysfunction or even failure of the organ both by a direct effect on the liver or by alteration in liver blood flow. It is important to recognize the signs and symptoms of liver failure in patients and identify possible causes including drug interactions. Furthermore, once a patient has been recognized to be suffering with liver dysfunction or failure drug choice and dosing regime will need to be rationalized.Paracetamol overdose can have severe and life-threatening consequences for patients due to its effect on liver function. It is the leading cause of acute liver failure in the UK. Correct and early management is crucial and will be discussed within this article.Drugs and the liverRakesh Vaja, Rebecca Caroline Barker10.1016/j.mpaic.2011.11.007Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XPharmacology7174http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002797/abstract?rss=yes(pp 56–58) Which of the following delay gastric emptying?MCQsHenry G.W. Paw, Vijayanand Nadella10.1016/j.mpaic.2011.11.014Anaesthesia & intensive care medicine 13, 2 (2012)2012-02-01Anaesthesia & intensive care medicine2012-02-01132S1472-0299(12)X0002-XTest yourself7575