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 © 2011 Published by Elsevier Inc. All rights reserved. Anaesthesia & intensive care medicine1472-0299131January 2012 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.anaesthesiajournal.co.uk/article/PIIS1472029911002803/abstract?rss=yesContents10.1016/S1472-0299(11)00280-3Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9OFCOFChttp://www.anaesthesiajournal.co.uk/article/PIIS1472029911002827/abstract?rss=yesEditorial Board10.1016/S1472-0299(11)00282-7Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9iihttp://www.anaesthesiajournal.co.uk/article/PIIS1472029911002384/abstract?rss=yesAbstract: Blood pressure is a determinant of blood flow, and is the sum of hydrostatic and dynamic pressures. Intravascular pressures can be measured directly using intravascular pressure sensors, or with external transducers connected by a fluid column. Early pressure transducers consisted of wire strain gauges, but these have been superseded by semiconductor devices, which have become increasingly mass-produced and miniaturized, using production techniques common in microelectronics. Performance of pressure-monitoring systems is affected by physical factors including resonance and damping. This article examines the physical principles that underlie transducer design and function, and the sources of error and inaccuracy.Principles of pressure transducers, resonance, damping and frequency responseMichael Gilbert10.1016/j.mpaic.2011.10.010Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Clinical measurement16http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002335/abstract?rss=yesAbstract: Beneficence, non-maleficence, autonomy and justice: these are the four pillars of modern medical ethics. To ensure beneficence, and non-maleficence in our treatment of patients we need the evidence of clinical trials. The Declaration of Helsinki of 1964, and its numerous amendments, provides the ethical ground rules for the conduct of clinical trials. Key elements include the concepts of informed consent, voluntary participation and the right to opt out, and that the well-being of the individual takes precedence over the interests of society. Randomization of patients is ethical only if there is equipoise between the different interventions. Patients should be entered into only those trials which are adequately powered. There is also the need to monitor the safety of trials and to stop the trial if there is loss of equipoise. Trial participants should also expect the same standard of confidentiality as other patients.For all the regulation of clinical trials there remain areas of controversy; does equipoise between treatments independently justify controlled research? Is it reasonable to compare a new treatment with placebo? Is it ethical to stop a trial early for commercial reasons? Does commercial funding of trials influence their results? There is certainly evidence to suggest publication bias since trials not showing benefit are rarely published. The issue of informed consent remains problematic for trials involving children, incompetent adults, emergency situations and the critically ill, but all these groups have the right to benefit from medical advances, some of which can be made only through clinical trials.The ethics of clinical trialsDaniel Horner, Bernard A. Foëx10.1016/j.mpaic.2011.10.005Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Ethics710http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002372/abstract?rss=yesAbstract: Paediatric cardiopulmonary arrest is an uncommon event in children, but with appropriate management of their prevention and treatment, outcomes can be reasonable. This article looks at the causes of arrests in children, the likely outcomes, and the ways in which this can be improved.Aetiology and outcome of paediatric cardiopulmonary arrestSally L. Wilmshurst, Cameron Graydon10.1016/j.mpaic.2011.10.009Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care1114http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002323/abstract?rss=yesAbstract: Fluid therapy in children requires an understanding of certain basic principles to avoid adverse events. Careful consideration needs to be given to both the appropriate rate and composition of the fluids to be administered with frequent re-assessment. Parenteral fluid management is used to meet maintenance requirements, correct any deficit and replace ongoing losses. Non-osmotic secretion of antidiuretic hormone (ADH) may occur, particularly in critically ill children and those in the perioperative period, resulting in an inability to compensate for an inappropriate administration of free water. Excess free water administration may result in cerebral oedema, which is poorly tolerated in children due to the proportionally larger size of the brain within the skull, compared to adults. Hyponatraemic encephalopathy continues to occur in hospitalized children and is associated with severe morbidity and mortality. Early recognition and aggressive management of this condition is required with hypertonic sodium chloride and further care within a paediatric high-dependency/intensive care unit. In the perioperative period concerns over hypoglycaemia have resulted in routine use of dextrose-containing solutions. However for the majority of children the stress response coupled with dextrose supplementation is likely to result in hyperglycaemia. Current recommendations regarding perioperative dextrose management are reviewed.Fluid and electrolyte balance in childrenMark Terris, Peter Crean10.1016/j.mpaic.2011.10.004Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care1519http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002347/abstract?rss=yesAbstract: The transfusion of a blood product into a child is associated with a greater risk of harm when compared to an adult. The younger the child, the greater the risks. This article will present information concerning lower levels of haemoglobin that can be tolerated without detrimental effects, and how blood loss can be assessed to ensure that blood products are not transfused unnecessarily.Transfusion guidelines in children: IRachel Hartrey10.1016/j.mpaic.2011.10.006Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care2023http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002359/abstract?rss=yesAbstract: This article will highlight techniques that have been used in order to reduce or avoid the use of blood products. It will also present the specific issues relating to the transfusion of blood products which must be considered in order to reduce the incidence of associated adverse events.Transfusion guidelines in children: IIRachel Hartrey10.1016/j.mpaic.2011.10.007Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care2427http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002293/abstract?rss=yesAbstract: This review outlines the current recommendations for use of intraosseous access in children. It describes the technique of intraosseous cannulation, anatomy, physiology and possible complications. It also briefly describes currently available devices that allow for rapid and effective intraosseous access in infants, children and young adults.Intraosseous cannulation in childrenPauline M. Cullen10.1016/j.mpaic.2011.10.001Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care2830http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002360/abstract?rss=yesAbstract: Trauma is the leading cause of preventable death in children, most often resulting from accidents involving motor vehicles or falls. A coordinated resuscitation effort in the early phase may contribute to improved morbidity and mortality outcomes. A multi-professional approach to the initial treatment of a critically injured child should be adopted: the primary survey aims to identify and manage immediately life-threatening conditions relating to a patients airway, breathing or circulatory system. Following cardiovascular stabilization, the secondary survey serves to structure a detailed examination for less severe or more occult injuries. Attention to fluid therapy, analgesia, thermoregulation and glucose homeostasis forms an important component of the secondary survey. Children injured in fires may have flame burns to the upper airway or have suffered smoke inhalation, where immediate control of the airway and ventilation may be challenging. Both flame burns and the more common scalds cause significant fluid losses and carry a high risk of mortality from late complications. This review discusses the principles of performing a primary and secondary survey in injured children, options for fluid resuscitation and outlines the management of children suffering from burns.Trauma and burns in childrenEmma-Beth Wilson, Jon G. McCormack10.1016/j.mpaic.2011.10.008Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Paediatric critical care3136http://www.anaesthesiajournal.co.uk/article/PIIS1472029911002785/abstract?rss=yes(pp 28–30) Which of the following are true regarding the uses and complications of intraosseous cannulation?MCQsHenry G.W. Paw, Vijayanand Nadella10.1016/j.mpaic.2011.11.013Anaesthesia & intensive care medicine 13, 1 (2012)2012-01-01Anaesthesia & intensive care medicine2012-01-01131S1472-0299(11)X0013-9Test yourself3737