{"title":"Sleep-disordered breathing and anaesthesia in the morbidly obese","authors":"Jonathan Dakin , Michael Margarson","doi":"10.1016/j.cacc.2009.10.008","DOIUrl":"10.1016/j.cacc.2009.10.008","url":null,"abstract":"<div><p>Clinically significant Sleep-Disordered Breathing (SDB) is commonly found in the morbidly obese population. The obesity epidemic has resulted in ever larger numbers of morbidly obese patients presenting for surgery, both for bariatric and other procedures. It is essential that anaesthetists are aware of these conditions, and the associated risks.</p><p>This article will focus on the common types of sleep-disordered breathing and investigation of these patients. It will discuss the issues around anaesthetising patients with these conditions, and suggest solutions to the problems that these patients present.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"21 1","pages":"Pages 24-30"},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.10.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79934199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Airway management in obese patients","authors":"John Myatt, Kevin Haire","doi":"10.1016/j.cacc.2009.09.004","DOIUrl":"10.1016/j.cacc.2009.09.004","url":null,"abstract":"<div><p><span>Airway management is often the principal concern of the majority of anaesthetists when presented with an obese patient for </span>general anaesthesia. Many anaesthetists will be increasingly encountering obese patients requiring all types of surgery. With the expansion of bariatric surgery both worldwide and in the UK, there is now a greater evidence base to inform and guide airway management in the obese patient. This article aims to improve understanding of the term ‘difficult airway’ in the obese population and focuses primarily on evidence related to pre-operative airway assessment and intra-operative airway management in the obese patient.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"21 1","pages":"Pages 9-15"},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78771200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Continuing professional development: Bariatric MCQs and self assesment","authors":"","doi":"10.1016/j.cacc.2009.10.007","DOIUrl":"https://doi.org/10.1016/j.cacc.2009.10.007","url":null,"abstract":"","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"21 1","pages":"Pages 41-43"},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92147887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anaesthetic considerations and management of the obese patient presenting for bariatric surgery","authors":"Tanya O'Neill, Joanna Allam","doi":"10.1016/j.cacc.2009.10.006","DOIUrl":"10.1016/j.cacc.2009.10.006","url":null,"abstract":"<div><p>The prevalence of morbid obesity in the United Kingdom is increasing at an exponential rate. The field of bariatric surgery has expanded accordingly over the past decade. Obesity related co-morbidity increases the risk of perioperative complications, and morbidly obese patients presenting for bariatric surgery pose particular challenges to the anaesthetist. This article addresses key issues relevant to pre-operative assessment, and anaesthetic management of morbidly obese patients presenting for bariatric surgery.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"21 1","pages":"Pages 16-23"},"PeriodicalIF":0.0,"publicationDate":"2010-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74417844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Glycopeptide resistant enterococci: What's the problem?","authors":"G. Birgand","doi":"10.1016/j.cacc.2009.07.001","DOIUrl":"10.1016/j.cacc.2009.07.001","url":null,"abstract":"<div><p>Enterococci are cocci gram-positive bacteria belonging to the bowel flora. Since the end of the 80s, glycopeptide resistant enterococci (GRE) have emerged in healthcare facilities. It has become a major public health issue in several countries. In USA, the rate of GRE was in 2003 about 30% of Enterococci isolated in intensive care units. In UK, 910 GRE bacteraemia has been reported by hospitals during 2007 with a majority of <em>Enterococcus faecium</em> owning the <em>vanA</em> phenotype. The emergence of the resistance to glycopeptides has increased difficulties in treating infected patients. Collectively, the potential transfer of the resistance gene to others pathogens like meticillin resistant <em>Staphylococcus aureus</em> is feared. The application of infection control guidelines and an appropriate use of antimicrobial agents could allow avoiding infections. This article had the aim to give an overview on problems associated to the spread of GRE and to provide some recommendation about the management of infected or colonized patients.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"20 5","pages":"Pages 248-250"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.07.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82923790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Posterior reversible encephalopathy syndrome (PRES) in a patient of eclampsia with ‘partial’ HELLP syndrome presenting with status-epilepticus","authors":"Harihar V. Hegde, Raghavendra P. Rao","doi":"10.1016/j.cacc.2009.07.004","DOIUrl":"10.1016/j.cacc.2009.07.004","url":null,"abstract":"<div><p>Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-neuroradiologic condition, not commonly reported in the literature. PRES is an uncommon complication of severe preeclampsia/eclampsia. We report the management of a 21<!--> <!-->y-female with peripartum eclampsia and ‘partial’ HELLP syndrome (haemolysis, elevated liver enzymes and low-platelets) presenting with status-epilepticus. She had neurological, cardiovascular, hepatic, renal and hematological involvement along with electrolyte abnormalities. Early diagnosis along with timely supportive therapy resulted in the successful management of this challenging case. Recent understanding on the pathophysiology of this uncommon condition is discussed. We highlight the importance to obstetricians, intensive-care physicians and anesthesiologists of recognizing such cases.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"20 5","pages":"Pages 251-253"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78529378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruth L. Savage , Desiree L. Kunac , Jeanette Johansson
{"title":"Appraising the post-marketing safety of medicines: A description of national and international pharmacovigilance with a focus on medicines used in chronic pain","authors":"Ruth L. Savage , Desiree L. Kunac , Jeanette Johansson","doi":"10.1016/j.cacc.2009.07.013","DOIUrl":"10.1016/j.cacc.2009.07.013","url":null,"abstract":"<div><p>Clinicians play a key role in appraising the safety of medicines after marketing. A wide variety of adverse reactions and novel interactions may occur in individual patients. Formal reporting by prescribers and evaluation of their observations to allow timely communication of risk back to the end users is vital. Many countries have regional or national pharmacovigilance centres which contribute to the World Health Organization (WHO) Global Individual Case Safety Report (ICSR) database, VigiBase. We describe the role of pharmacovigilance in detecting and evaluating emerging evidence of adverse drug reactions, i.e. “signals” using the New Zealand Pharmacovigilance Centre as an example. The benefits to individual patient safety through a medical warning system are of particular relevance to anaesthetic practice. Effective and holistic pharmacovigilance relies on voluntary reporting systems for all therapeutic products, prescription or cohort event monitoring of selected medicines and vaccines, and specific monitoring of medication error. Ongoing development of computational methods for data-mining in the voluntary reporting databases for signal detection and the application of these methods to electronic longitudinal health care databases such as general practice records in order to detect, confirm or refute, and characterise signals of adverse drug reactions are also described.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"20 5","pages":"Pages 215-220"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.07.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78528297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuropathic pain and drug safety MCQs and self-assessment","authors":"","doi":"10.1016/j.cacc.2009.08.002","DOIUrl":"https://doi.org/10.1016/j.cacc.2009.08.002","url":null,"abstract":"","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"20 5","pages":"Pages 222-224"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.08.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137313267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Complex regional pain syndrome – Mechanisms, diagnosis, and management","authors":"Edward A. Shipton","doi":"10.1016/j.cacc.2009.07.012","DOIUrl":"10.1016/j.cacc.2009.07.012","url":null,"abstract":"<div><p>Complex regional pain syndrome (CRPS) is a chronic neurological disorder characterized by regional disabling pain, increased sensitivity to tactile stimuli, swelling, vasomotor and sudomotor abnormality, and impairment of motor function. The disorder usually develops after minor trauma (contusions, sprains, and fractures) or surgery. No specific diagnostic test is available; hence, diagnosis is based mainly on history, clinical examination, and supportive laboratory findings. Evidence suggests that this interaction between peripheral and central systems arises from a number of sources including sympathetic–afferent coupling, re-organization of the central autonomic control, and changes in the somatomotor system and peripheral inflammation. Oral, topical, and intravenous medications targeting alpha-adrenergic receptors (clonidine) and the sympathetic nervous system have not been proven effective by Randomised Controlled Trials. The most commonly used agents, such as anticonvulsants, antidepressants, and opioids, have been found to be useful for other neuropathic pain conditions in large-scale trials but have not been adequately studied in CRPS. This article explores an interdisciplinary setting with comprehensive approach (pharmacological, interventional, and psychological in conjunction with rehabilitation pathway) as the protocol for the practical management of CRPS. Insight in predisposing factors may facilitate early diagnosis and elucidate underlying mechanisms that could provide targets for pharmacotherapy.</p></div>","PeriodicalId":81055,"journal":{"name":"Current anaesthesia and critical care","volume":"20 5","pages":"Pages 209-214"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cacc.2009.07.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88604926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}