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 © 2010 Published by Elsevier Inc. All rights reserved. Anaesthesia & intensive care medicine1472-0299119September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.anaesthesiajournal.co.uk/article/PIIS1472029910001864/abstract?rss=yesContents10.1016/S1472-0299(10)00186-4Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1OFCOFChttp://www.anaesthesiajournal.co.uk/article/PIIS1472029910001888/abstract?rss=yesEditorial Board10.1016/S1472-0299(10)00188-8Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1iihttp://www.anaesthesiajournal.co.uk/article/PIIS1472029910001311/abstract?rss=yesAbstract: Coma is caused by temporary or permanent damage to the ascending reticular system or to both cerebral hemispheres. It follows that the differential diagnosis of coma is wide. Emergency management of the comatose patient should be instituted as soon as possible to prevent secondary cerebral injury. Accurate diagnosis of the cause requires careful history taking and meticulous general medical and neurological examination followed by targeted investigations.ComaTimothy Liversedge, Nicholas Hirsch10.1016/j.mpaic.2010.05.008Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurointensive care337339http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001335/abstract?rss=yesAbstract: Stroke is a clinical syndrome caused by a sudden loss of blood flow to a specific area of the brain. In 85% of cases it is due to cerebral vessel thrombosis or embolism resulting in focal ischaemia. If administered soon after the onset of symptoms thrombolytic therapy can reverse neurological deficit due to ischaemic stroke.Ischaemic strokeRobin Howard10.1016/j.mpaic.2010.05.010Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurointensive care340342http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001529/abstract?rss=yesAbstract: The brain uses large amounts of glucose for its basal energy requirements, and these are further increased during cerebral activation. In order that glucose can provide this energy, a plentiful and uninterrupted supply of oxygen is necessary. Cerebral blood flow 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. This article reviews cerebral metabolism and cerebral blood flow and techniques by which both can be monitored.Applied cerebral physiologyChristopher Taylor, Nicholas Hirsch10.1016/j.mpaic.2010.06.004Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia343348http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001347/abstract?rss=yesAbstract: Anaesthesia for neurosurgery aims to provide optimal surgical conditions whilst maintaining adequate cerebral blood flow in order to supply the brain with appropriate amounts of oxygen and glucose. Most anaesthetic drugs influence the normal cerebral physiology either directly or indirectly. They can cause changes in cerebral blood flow by influencing cerebral blood vessel calibre, by interfering with autoregulatory processes and by modifying cerebral metabolism. The brain’s limited ability to store oxygen and glucose means that its supply must be continuous if neuronal damage is to be avoided. Ischaemic cerebral damage is the most important pathological mechanism in patients with stroke, subarachnoid haemorrhage and traumatic brain injury. Significant traumatic brain injury causes widespread derangement of cerebral physiology, including changes in cerebral blood flow, autoregulation and cerebral energy dynamics. This article outlines the effect of anaesthesia on cerebral physiology and reviews the pathophysiology of traumatic brain injury and subarachnoid haemorrhage.Pharmacological and pathological modulation of cerebral physiologyNicholas Hirsch, Christopher Taylor10.1016/j.mpaic.2010.05.011Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia349354http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001499/abstract?rss=yesAbstract: This article gives a short description of the circulation of the cerebrospinal fluid and of the technique of cisternal puncture.Cerebrospinal fluid and its circulationJohn Craven10.1016/j.mpaic.2010.06.001Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia355356http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001359/abstract?rss=yesAbstract: The aims of the preoperative assessment of neurosurgical patients include exchange of information, reassuring the anxious patient, establishing whether raised intracranial pressure is present and optimizing any co-existing medical problems, which may or may not be related to the neurological condition. The patient’s neurological status must be assessed and documented preoperatively as it will impact on the anaesthetic and is vital for assessing the patient in the postoperative period. Patients often have co-morbidity and are commonly taking hypoglycaemic, anticonvulsant, anticoagulant, antihypertensive, corticosteroid, and chronic pain medication, all of which may influence the conduct of anaesthesia. Fluid and electrolyte disturbances are common as a result of the underlying condition or of the treatment received. It is important that these are identified and corrected preoperatively. Difficult airways are encountered frequently (e.g. in patients with cervical spine abnormalities or acromegaly) and it is therefore particularly important to carry out a detailed airway assessment and construct a plan for airway management. The preoperative assessment and consideration of the underlying neuropathology allow formulation of an appropriate and safe plan for induction, airway management, maintenance of anaesthesia and postoperative care.Preoperative assessment of neurosurgical patientsUgan Reddy, Yogen Amin10.1016/j.mpaic.2010.05.012Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia357362http://www.anaesthesiajournal.co.uk/article/PIIS147202991000130X/abstract?rss=yesAbstract: Neuroanaesthesia provides a unique set of challenges, in which anaesthetists’ knowledge and techniques may directly influence patient outcome. As neurosurgery evolves it has provided neuroanaesthetists with an ever-changing speciality especially in minimally invasive and functional techniques.Anaesthesia for neurosurgeryTamsin Gregory, Sally R. Wilson10.1016/j.mpaic.2010.05.007Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia363365http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001542/abstract?rss=yesAbstract: The specialty of interventional neuroradiology has expanded enormously over the last few years and in addition to treating intracranial aneurysms, arteriovenous malformations (AVMs) and dural fistulae, there is increasing involvement in the embolization of tumours and the treatment of vasospasm and stroke. An appreciation of the physiological requirements and potential problems relating to each individual procedure permits the close cooperation between anaesthetist and radiologist that is essential in order to provide the optimum working conditions. This attention to detail must extend into the post-procedural period when the patients should be recovered in an environment where close attention to neurological examination and the recognition of potentially subtle changes warranting action must be appreciated.Anaesthesia for interventional neuroradiologyTamsin Gregory, Ian Appleby10.1016/j.mpaic.2010.06.006Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia366368http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001323/abstract?rss=yesAbstract: The prion diseases are a group of invariably fatal neurodegenerative conditions caused by a structurally abnormal form of the naturally occurring cellular prion protein. Although all are rare, interest over the last 15 years has been intense due to the appearance of a new prion disease – variant Creutzfeldt–Jakob disease which is caused by ingestion of meat from cattle suffering from bovine spongiform encephalopathy. The disease is transmissible and therefore has implications for the anaesthetist including the use of airway devices, fibreoptic equipment and blood transfusion.Prion diseasesNicholas Hirsch10.1016/j.mpaic.2010.05.009Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Neurosurgical anaesthesia369371http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001530/abstract?rss=yesAbstract: There has been an explosion of interest in the simultaneous study of a large number of biologically relevant molecules; the most well-known example being the study of a large number of genes or genomics with these large number of genes forming the genome. Similarly the study of the translation products of these genes; proteins (the proteome) can be investigated in proteomics and metabolic products (metabolome) in metabolomics (or metabonomics). It is possible to compare, for example, the proteome of control and diseased tissues to identify disease-related differences. This process/technology is of interest to clinicians in that it may lead to the production of novel diagnostic tests and the design of novel and even personalized therapeutics.Proteomics and metabolomicsDavid G. Lambert10.1016/j.mpaic.2010.06.005Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Pharmacology372373http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001517/abstract?rss=yesAbstract: Pharmacogenetics is the study of the effects of particular genes on the variation in drug response and pharmacogenomics is the study of the effects of the whole genome on drug response. There are many examples from anaesthesia where a genetic linkage to response is known. These include cholinesterase and suxamethonium. Genetic variation can occur at all stages in the pharmacological process; pharmacokinetic and pharmacodynamic. The response to morphine can be influenced by for example, genetic variation in cytochrome P450 (pharmacokinetic) and the μ opioid receptor (pharmacodynamic). Understanding and being able to screen for these genetic variations in drug response may enable a more personalized drug use with greater benefit and reduced side effects.PharmacogenomicsDavid G. Lambert10.1016/j.mpaic.2010.06.003Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Pharmacology374376http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001505/abstract?rss=yesAbstract: This 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 electro-chemical 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 i.e. 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.Ion channels, receptors, agonists and antagonistsCameron J. Weir10.1016/j.mpaic.2010.06.002Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Pharmacology377383http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001293/abstract?rss=yesAbstract: The plasma membrane forms the interface between the cell and its environment. It is composed essentially of a phospholipid matrix and many different types of protein molecules which may be embedded within the matrix (integral proteins) or more loosely associated with the cytoplasmic ‘face’ of the membrane (peripheral proteins). The passage of essential ions and molecules across the membrane is controlled by integral proteins acting as channels or transporters. Intercellular communication is mediated by protein receptors, which are activated by signalling molecules such as hormones and neurotransmitters. Physical contact between the cell and its environment (and between cells) is mediated by membrane adhesion proteins. The plasma membrane is a highly dynamic structure in terms of molecular composition and topological configuration. The linkage of the internal cytoskeleton to the plasma membrane (via peripheral and integral proteins) expedites cellular shape changes or amoeboid motion of some types of cell. The process of endocytosis enables the cell to internalize small volumes of extracellular fluid (pinocytosis) by invagination and formation of intracellular vesicles or to engulf entire cells by phagocytosis. Secretion of molecules, such as hormones, is accomplished by fusion of intracellular vesicles with the plasma membrane. This mechanism of exocytosis is mediated by another type of protein: the SNARE proteins.The cell membrane and receptorsAllan Fletcher10.1016/j.mpaic.2010.05.006Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Physiology384388http://www.anaesthesiajournal.co.uk/article/PIIS1472029910001554/abstract?rss=yes(pp 366–368) Which of the following increase the risk of contrast induced nephropathy?MCQsHenry G.W. Paw, Vijayanand Nadella10.1016/j.mpaic.2010.06.007Anaesthesia & intensive care medicine 11, 9 (2010)2010-09-01Anaesthesia & intensive care medicine2010-09-01119S1472-0299(10)X0009-1Test yourself389389