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https://www.readbyqxmd.com/read/29161401/the-evolution-of-airway-management-new-concepts-and-conflicts-with-traditional-practice
#1
A F McNarry, A Patel
In the last 25 yr, there have been several advances in the safe management of the airway. Videolaryngoscopes and supraglottic airways, now in routine use by new trainees in anaesthesia, have had their genesis in the recent past. The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society published in 2011 a seminal report that has influenced airway management worldwide . Understanding how the report's recommendations were constructed and how clinical guidelines compliment rather than contradict them is important in understanding the tenets of safe airway management...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161400/the-evolution-of-robotic-surgery-surgical-and-anaesthetic-aspects
#2
H Ashrafian, O Clancy, V Grover, A Darzi
Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. We examine the challenges, obstacles and limitations of robotic surgery and its future potential including integrated real-time anatomical and immune-histological imaging and data assimilation with improved visualisation, haptic feedback and robot-surgeon interactivity...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161398/role-of-gabaa-receptor-subtypes-in-the-behavioural-effects-of-intravenous-general-anaesthetics
#3
C J Weir, S J Mitchell, J J Lambert
Since the introduction of general anaesthetics into clinical practice, researchers have been mystified as to how these chemically disparate drugs act to produce their dramatic effects on central nervous system function and behaviour. Scientific advances, particularly during the last 25 years, have now begun to reveal the molecular mechanisms underpinning their behavioural effects. For certain i.v. general anaesthetics, such as etomidate and propofol, a persuasive case can now be made that the GABAA receptor, a major inhibitory receptor in the mammalian central nervous system, is an important target...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161397/abdominal-aortic-aneurysm-repair-in-the-united-kingdom-an-exemplar-for-the-role-of-anaesthetists-in-perioperative-medicine
#4
S J Howell
The past two decades have seen an increasing recognition that the delivery of safe surgery with low complication rates and good long-term outcomes is a team endeavour embracing the whole patient care pathway. The key role of the anaesthetist in managing the patient through the surgical process is widely understood and has driven the emergence of perioperative medicine. In parallel with these developments there has been a sea change in the organisation of the care of patients presenting for elective abdominal aortic aneurysm (AAA) repair...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161395/postoperative-cognitive-dysfunction-and-dementia-what-we-need-to-know-and-do
#5
M J Needham, C E Webb, D C Bryden
Approximately 12% of apparently previously cognitively well patients undergoing anaesthesia and noncardiac surgery will develop symptoms of cognitive dysfunction after their procedure. Recent articles in this Journal have highlighted the difficulties of confirming any clear links between anaesthesia and cognitive dysfunction, in part because of the lack of consistency regarding definition and diagnosis. Postoperative cognitive dysfunction (POCD) is usually self-limiting and rarely persists in the longer term, although plausible biological mechanisms for an impact on brain protein deposition do exist...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161394/managing-anaesthetic-provision-for-global-disasters
#6
R M Craven
The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the affected country is least able to respond. For this reason an international disaster response is often required. For many years this disaster response was not coordinated. The response consisted of what was available not what was needed and standards of care varied widely producing a healthcare lottery for the affected population. In recent years the World Health organisation has initiated the Emergency Medical Team programme to coordinate the response to disasters and set minimum standards for responding teams...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161392/the-future-united-kingdom-anaesthetic-workforce-training-education-and-role-boundaries-for-anaesthetists-and-others
#7
A E Cooper
Anaesthesia is the largest hospital-based specialty in the UK, and the activities of the anaesthesia workforce underpin the care of all patients in the hospital sector. Changes in the way care will be delivered in the future will impact on the workforce as a consequence of patient requirements and funding issues. This article considers these and other factors in the context of the current and future workforce.
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161390/thiopental-to-desflurane-an-anaesthetic-journey-where-are-we-going-next
#8
J R Sneyd
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161386/to-err-is-human-use-of-simulation-to-enhance-training-and-patient-safety-in-anaesthesia
#9
H Higham, B Baxendale
Human beings who work in complex, dynamic, and stressful situations make mistakes. This is as true for anaesthetists as for any other health-care professional, but we face unique challenges in the many roles and responsibilities we have in diverse clinical contexts. As a profession, we are well versed in the development and utilization of improvement techniques and technologies that prioritize high-quality, safe care for patients. This article focuses on one particular domain of patient safety in which anaesthetists have been pre-eminent, the use of simulation in training to improve both professional capabilities and patient safety in anaesthetic practice...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29158992/hrv-derived-data-similarity-and-distribution-index-based-on-ensemble-neural-network-for-measuring-depth-of-anaesthesia
#10
Quan Liu, Li Ma, Ren-Chun Chiu, Shou-Zen Fan, Maysam F Abbod, Jiann-Shing Shieh
Evaluation of depth of anaesthesia (DoA) is critical in clinical surgery. Indices derived from electroencephalogram (EEG) are currently widely used to quantify DoA. However, there are known to be inaccurate under certain conditions; therefore, experienced anaesthesiologists rely on the monitoring of vital signs such as body temperature, pulse rate, respiration rate, and blood pressure to control the procedure. Because of the lack of an ideal approach for quantifying level of consciousness, studies have been conducted to develop improved methods of measuring DoA...
2017: PeerJ
https://www.readbyqxmd.com/read/29156486/-update-in-obstetric-anesthesia-tried-and-trusted-methods-controversies-and-new-perspectives
#11
Peter Kranke, Thorsten Annecke, Dorothee H Bremerich, Daniel Chappell, Thierry Girard, Wiebke Gogarten, Robert Hanß, Lutz Kaufner, Sophie Neuhaus, Tobias Ninke, Thomas Standl, Stefan Weber, Yvonne Jelting, Thomas Volk
Since 1975, a plethora of lectures within the context of annual meetings relevant for the clinical care has been summarized in "what's new in obstetric anesthesia" by the society for Obstetric anesthesia and Perinatology which can be recommended to everyone interested in anaesthesiology in the delivery room. After the death of Gerard W. Ostheimer, Professor of Anaesthesiology at Brigham and Women's Hospital in Boston, Massachusetts, it became renamed the Gerard W. Ostheimer "what's new in obstetric anesthesia" lecture to honor his contributions to regional anesthesia and obstetric anaesthesia...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29153101/local-anaesthetics-more-than-meets-the-eye
#12
EDITORIAL
Michèle Dumoulin, Maarten Oosterlinck
No abstract text is available yet for this article.
October 2017: Veterinary Journal
https://www.readbyqxmd.com/read/29152410/ultrasound-triggered-local-anaesthesia
#13
Alina Y Rwei, Juan L Paris, Bruce Wang, Weiping Wang, Christopher D Axon, María Vallet-Regí, Robert Langer, Daniel S Kohane
On-demand relief of local pain would allow patients to control the timing, intensity and duration of nerve block in a safe and non-invasive manner. Ultrasound would be a suitable trigger for such a system, as it is in common clinical use and can penetrate deeply into the body. Here, we demonstrate that ultrasound-triggered delivery of an anaesthetic from liposomes allows the timing, intensity and duration of nerve block to be controlled by ultrasound parameters. On insonation, the encapsulated sonosensitizer protoporphyrin IX produces reactive oxygen species that react with the liposomal membrane, leading to the release of the potent local anaesthetic tetrodotoxin...
2017: Nature biomedical engineering
https://www.readbyqxmd.com/read/29152313/pharmacokinetic-profile-and-partitioning-in-red-blood-cells-of-romifidine-after-single-intravenous-administration-in-the-horse
#14
Noemi Romagnoli, Khaled M Al-Qudah, Sara Armorini, Carlotta Lambertini, Anna Zaghini, Alessandro Spadari, Paola Roncada
The aims of this study were to assess the plasma concentrations of romifidine in horses after intravenous injection, to evaluate the red blood cell (RBC) partitioning of the anaesthetic drug, and to improve knowledge regarding its sedative effect in horses describing the pharmacokinetic model. Eight adult Standardbred horses received a single bolus of romifidine at a dosage of 100 μg/kg. Blood samples (5 mL) were collected immediately before romifidine administration (t0), and at 2, 5, 10, 15, 20, 25, 30, 40, 50, 60, 75, 90, 105, 120, 150 and 180 min after injection...
November 2017: Veterinary Medicine and Science
https://www.readbyqxmd.com/read/29151071/an-observational-cohort-study-of-3-units-versus-5-units-slow-intravenous-bolus-oxytocin-in-women-undergoing-elective-caesarean-delivery
#15
N Terblanche, P Otahal, A Messmer, P Wright, S Patel, K Nathan, J E Sharman
This study sought to compare postpartum blood loss and maternal outcomes after 3IU and 5IU oxytocin at elective caesarean delivery. In a prospective observational study, 73 women undergoing elective caesarean delivery under spinal anaesthetic received a slow I.V. injection of either 3IU (n = 35) or 5IU (n = 38) oxytocin after delivery. The main outcome was gravimetrically measured 24-hour postpartum blood loss with a non-inferiority margin of 300 mL. Uterine tone, phenylephrine dose, emesis and hypotension after oxytocin administration were secondary outcomes...
August 2017: Journal of Physiology and Pharmacology: An Official Journal of the Polish Physiological Society
https://www.readbyqxmd.com/read/29149469/cuffed-versus-uncuffed-endotracheal-tubes-for-general-anaesthesia-in-children-aged-eight-years-and-under
#16
REVIEW
Flavia A De Orange, Rebeca Gac Andrade, Andrea Lemos, Paulo Sgn Borges, José N Figueiroa, Pete G Kovatsis
BACKGROUND: Since the introduction of endotracheal intubation in paediatrics, uncuffed endotracheal tubes (ETTs) have been the standard of care for children under eight years old, based on the presumption that complications, particularly postoperative stridor, are higher with cuffed ETTs. The major disadvantages of uncuffed ETTs cited for this shift in procedure include the difficulty in achieving tidal volumes due to leakage around an uncuffed ETT. To seal the airway adequately, uncuffed tubes may need to be exchanged for another tube with a larger diameter, which sometimes requires several attempts before the appropriate size is found...
November 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29148237/supraclavicular-flap-repair-in-the-free-flap-era
#17
REVIEW
Jodie Trautman, Sinclair Gore, Matthew Potter, Jonathan Clark, Dylan Hyam, Ngian C Tan, Quan Ngo, Bruce Ashford
BACKGROUND: Supraclavicular flap (SCF) repair is widely reported in head and neck surgery in select patients and defects. The authors' objective is to present our series of 30 patients who underwent SCF repair for varying defects and to review the scope and outcome of SCF repair in the literature. METHODS: The authors contributed primary evidence of 30 cases of SCF repair. Our outcomes are compared with those reported in the last 5 years' literature; 33 articles published between January 2012 and January 2017 that present original clinical experience of 528 SCFs...
November 17, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29146275/beat-to-beat-variations-in-activation-recovery-interval-derived-from-the-right-ventricular-electrogram-can-monitor-arrhythmic-risk-under-anesthetic-and-awake-conditions-in-the-canine-chronic-atrioventricular-block-model
#18
Sofieke C Wijers, David J Sprenkeler, Alexandre Bossu, Albert Dunnink, Jet D M Beekman, Rosanne Varkevisser, Alfonso Aranda Hernández, Mathias Meine, Marc A Vos
BACKGROUND: In the chronic atrioventricular block (CAVB) dog model, beat-to-beat variation of repolarization in the left ventricle (LV) quantified as short-term variability of the left monophasic action potential duration (STVLVMAPD) increases abruptly upon challenge with a pro arrhythmic drug. This increase occurs before the first ectopic beat (EB), specifically in subjects that demonstrate subsequent repetitive Torsade de Pointes arrhythmias (TdP). OBJECTIVE: Demonstrate that STV is feasible to monitor arrhythmic risk through the use of the intracardiac electrogram (EGM) derived from the right ventricle (RV) lead from pacemakers or implantable cardioverter defibrillators (ICD)...
November 13, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/29141003/trpa1-and-trpv1-are-required-for-lidocaine-evoked-calcium-influx-and-neuropeptide-release-but-not-cytotoxicity-in-mouse-sensory-neurons
#19
Mirjam Eberhardt, Thomas Stueber, Jeanne de la Roche, Christine Herzog, Andreas Leffler, Peter W Reeh, Katrin Kistner
BACKGROUND: Local anaesthetics (LA) reduce neuronal excitability by inhibiting voltage-gated Na+ channels. When applied at high concentrations in the direct vicinity of nerves, LAs can also induce relevant irritation and neurotoxicity via mechanisms involving an increase of intracellular Ca2+. In the present study we explored the role of the Ca2+-permeable ion channels TRPA1 and TRPV1 for lidocaine-induced Ca2+-influx, neuropeptide release and neurotoxicity in mouse sensory neurons. METHODS: Cultured dorsal root ganglion (DRG) neurons from wildtype and mutant mice lacking TRPV1, TRPA1 or both channels were explored by means of calcium imaging, whole-cell patch clamp recordings and trypan blue staining for cell death...
2017: PloS One
https://www.readbyqxmd.com/read/29140997/topical-anaesthesia-reduces-sensitivity-of-castration-wounds-in-neonatal-piglets
#20
Sabrina Lomax, Charissa Harris, Peter A Windsor, Peter J White
The aim of this study was to do determine the efficacy of the topical anaesthetic Tri-Solfen® in the amelioration of the pain of castration in piglets. The trial was conducted over a three day period, and blocked across six litters with 12 piglets treated on days one and two, and 16 on day three. The piglets were randomly allocated by weight and litter to 1 of 4 treatment groups: (i) sham castration (SHAM; n = 10); (ii) surgical castration with no anaesthetic intervention (CAST; n = 10); (iii) surgical castration with post-operative topical anaesthesia (TRI; n = 10); (iv) surgical castration with a pre-operative intra-testicular lignocaine hydrochloride injection (LIG; n = 10)...
2017: PloS One
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