Update General Topics

The anaesthetist’s involvement will range from participating in the resuscitation of patients with polytrauma to the provision of safe anaesthesia to allow surgical treatment for cervical spine or other injuries. The importance of early immobilization is emphasised and strategies used to ‘clear’ the cervical spine are described.Acute Cervical Spine Injury – June 1, 2008

Oxygen has been used in clinical practice for more than 200 years. It is probably the most widely prescribed medication in pre-hospital and hospital environments. If appropriately used it is life-saving and part of first-line treatment in many critical conditions. As with any drug, oxygen should be used when indicated, in appropriate dosage (concentration), and correctly administered for a planned duration.
Acute Oxygen Treatment – December 1, 2000

Electro convulsive therapy (ECT) is the electrical induction of a grandmal seizure. It is an effective therapy used as part of the treatment of several psychiatric conditions including depression, mania, catatonic schizophrenia and other psychosis. A short general anaesthetic is usually given for the procedure.Anaesthesia for Electroconvulsive Therapy – June 1, 2003

Management of these high risk patients is addressed with an emphasis on reducing postoperative complicationsAnaesthesia for Patients with Cardiac Disease Undergoing Non-cardiac Surgery – June 1, 2002

One of the major risks posed by patients who have not been prepared for theatre is that they may not have an empty stomach. Aspiration pneumonitis is especially severe, and often fatal, if the gastric contents are markedly acidic (pH < 2.5). As little as 30mls will cause a severe reaction. When solid foodstuffs are aspirated complete obstruction of the airway may occur.Anaesthesia for the Patient with a Full Stomach – June 1, 1994

Modern hospital practice has seen the role of the anaesthesiogist expand beyond the operating theatre complex. While the operating theatres have experienced staff, adequate equipment and monitors, providing anaesthesia outside this complex is challenging and requires expertise and skill.Anaesthesia Outside the Operating Theatre – June 1, 2009

As a new trainee in anaesthesia one of the most important skills to acquire is anaesthetic decision making, in particular choosing the most suitable anaesthetic for a particular patient. We propose an algorithm that allows the novice trainee to conceptualise the process in a simple, logical and sequential way.Anaesthetic decision making – October 28, 2011

Anaesthetic novice decision support algorithm Download – Anaesthetic novice decision support algorithm (Update 2011) Rachel Rogers and Alastair HellewellAnaesthetic novice decision support algorithm – October 28, 2011

Several scoring systems have been devised to describe patients scheduled for surgery and anaesthesia, the best known are the ASA and the CEPOD scores.ASA and CEPOD Scoring – June 2, 2002

Atrial fibrillation (AF) is one of the commonest arrhythmias. It may be paroxysmal (sudden episodes), persistent or permanent. Atrial depolarization is very rapid, irregular and disorganized. This causes irregular and rapid ventricular conduction. AF may be seen in patients presenting for anaesthesia or may occur during anaesthesia.Atrial Fibrillation and Anaesthesia – June 1, 2006

Adequate blood pressure is essential to maintain the blood supply and function of vital organs. Measurement of blood pressure is therefore a key part of the monitoring of patients during anaesthesia and critical care.Blood Pressure Measurement – June 1, 2000

The serious complications of blood transfusion are described. Although immunologically mediated reactions to transfusion products are potentially serious, anaesthetists are most likely to encounter those relating to massive blood transfusion and transfusion related acute lung injury (TRALI). Blood Transfusion – Complications – June 1, 2007

This article focuses on the breathing systems used with plenum anaesthetic machines (those with a supply of pressurized gas); drawover apparatus will be described in a future article.Breathing Systems – December 1, 2008

Bronchospasm is a relatively common event during general anaesthesia. This articles describes managemetnt of this emergency using a simple algorithm.Bronchospasm during anaesthesia – October 28, 2011

Estimation of cardiac output has an important role in patient management during anaesthesia and critical care. Cardiac output can be measured in a number of ways, from simple clinical assessment to invasive haemodynamic monitoring.Cardiac output monitoring (Update 28, 2012) – December 21, 2012

This article decribes the issues to consider when anaesthetising a patient with chronic renal failure.Chronic Renal Failure and Anaesthesia (Update 11) – June 1, 2000

This review concentrates on the more common pathophysiological changes of CRF encountered of relevance to anaesthesia.Chronic Renal Failure and Anaesthesia (Update 18) – June 1, 2004

Blood used correctly can be life saving, used inappropriately it can endanger life. It is important to remember that blood transfusion is only one part of the patient’s management. The decision to transfuse blood or blood products should always be based on a careful assessment of clinical and laboratory indications that transfusion is necessary to save life or prevent significant morbidity.Clinical Use of Blood – June 1, 2002

Continuous flow anaesthetic machines date back to the first availability of compressed gases, and despite numerous modifications the modern apparatus retains many of the features of the original Boyle’s machine, a British Oxygen Company trade name in honour of the British anaesthetist H E G Boyle (1875- 1941). This article describes the basic principles of continuous flow apparatusContinuous Flow Anaesthetic Apparatus – The Boyle’s Machine – June 1, 1996

At the end of anaesthesia and surgery the patient should be awake or easily rousable, protecting their airway, maintaining adequate ventilation and with their pain under control. Time to emerge from anaesthesia is very variable and depends on many factors related to the patient, the type of anaesthetic given and the length of surgery.Delayed Awakening from Anaesthesia – June 1, 2001

The guidelines in this article help to identify the multiple problems caused by diabetes mellitus and give advice on on how to cope with them.
Diabetes Mellitus – Management During Anaesthesia – June 1, 2000

During routine anaesthesia the incidence of difficult tracheal intubation has been estimated at 3-18%. Difficulties in intubation have been associated with serious complications, particularly when failed intubation has occurred. If the anaesthetist can predict which patients are likely to prove difficult to intubate, he may reduce the risks of anaesthesia considerably. This paper reviews clinical techniques used for predicting difficulties in intubation and suggests different approaches to manage these patients.Difficult Tracheal Intubation – Prediction and Management – December 1, 1998

This article describes the ways in which draw-over apparatus can be used to provide safe, high quality anaesthesia.Drawover anaesthesia Parts 2 and 3 (Update 3) – December 1, 1993

This paper discusses the equipment and role of drawover anaesthesia for the uninitiated ‘plenum anaesthetist’ while also delving into some of the finer aspects for experienced users.Drawover Anaesthesia Review (Update 15) – December 1, 2002

Cardiac arrhythmias during anaesthesia and surgery occur in up to 86% of patients. Many are of clinical significance and therefore their detection is of considerable importance. This article will discuss the basic principles of using the ECG monitor in the operating theatre. It will describe the main rhythm abnormalities and give practical guidance on how to recognise and treat them.ECG Monitoring in Theatre – June 1, 2000

Increasing numbers of elderly patients are presenting for surgery due to longer life expectancy. The incidence of peri-operative complications is much higher in these patients due to reduced functional reserve and a high incidence of co-morbidity, but these complications can be minimised by careful preoperative assessment, a meticulous anaesthetic technique and good postoperative care.Elderly Patients and Anaesthesia – December 1, 2002

The principles of anaesthesia for the patient requiring emergency abdominal surgery are common to adults and children, and to the patient and their anaesthetist wherever they are, and whatever resources are available. The major part of the article is about general anaesthesia, with some comments on regional anaesthesia, which may be the only option on some occasions.Emergency Abdominal Surgery – December 1, 2002

Enhanced recovery after surgery involves implementation of change to many components of surgical care pathways. The proven benefits are reduction in morbidity and mortality as well as reduced hospital stay. The evidence behind these strategies is discussed in this article.Enhanced Recovery After Surgery – December 1, 2010

Almost all tracheal intubations are performed with the expectation of subsequent extubation. However there is a relative lack of guidance and research regarding this key aspect of anaesthetic care. We present a systematic review of the available evidence for management of extubationExtubation after Anaesthesia – June 1, 2009

Awake fibreoptic intubation is a useful technique where difficult intubation is anticipated on the basis of airway examination or previous anaesthesia. Adequate anaesthesia of the airway is essential for a safe successful procedure and we describe our preferred technique along with alternatives.
Fibreoptic intubation – October 28, 2011