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Posted in: ATOTW > Obstetric Anaesthesia 2017 Language: english

The second article of this labour epidural series features 4 cases requiring identification of the most appropriate neuraxial technique. It covers why epidurals fail and how these failures may be rectified.

Posted in: ATOTW > Obstetric Anaesthesia 2017 Language: english

The two articles in this series will provide an overview of epidurals for labour analgesia. The first article covers the indications and contraindications for labour epidurals, anatomy and the range of neuraxial approaches available.

Posted in: ATOTW > Paediatric Anaesthesia 2017 Language: english

Outcomes in neonates with tracheo-oesophageal fistula with or without oesophageal atresia (TOF/OA) have improved significantly due to advances in surgical, anaesthetic, and critical care management. However, mortality rates remain high in low resource settings. Here we describe the preoperative, intraoperative, and postoperative management of infants with TOF/OA, while focusing on approaches used in different resource settings.

Posted in: ATOTW > General Topics 2017 Language: english

Due to increased patient life expectancy and number of total hip replacements being performed annually, the burden of revision hip surgery is increasing. Surgery is complex and creates unique challenges for the anaesthetist. This tutorial summarizes the surgical techniques, potential peri-operative complications and anaesthetic care of these patients.

Posted in: ATOTW > Basic Sciences 2017 Language: english

Humidification of inspired gases is vital for the safe practice of anesthesia. This article focuses on the basic science of humidification, its measurement and its relevance in anaesthesia clinical practice.

Posted in: ATOTW > Basic Sciences & General Topics 2017 Language: english

Coronary angiography is increasingly performed pre-operatively to investigate for the presence of coronary artery disease. As peri-operative physicians, we need a basic understanding of coronary angiography and terminology used. This tutorial aims to give an overview of coronary anatomy and provide a working knowledge of coronary angiography.

Posted in: ATOTW > General Topics 2017 Language: english

This tutorial is a comprehensive review of up to date evidence regarding management of both the elective patient with known or suspected sleep apnoea and the emergency patient. Together with a practical approach to risk stratification and management, this tutorial provides a holistic approach to perioperative management of these patients.

Posted in: ATOTW > Obstetric Anaesthesia 2017 Language: english

Multiple Sclerosis is an autoimmune disease of the central nervous system that effects 1 million people worldwide, of which two-thirds are women and many are in their child-bearing years. The effects of pregnancy on disease progression, pregnancy outcome as well as anesthetic considerations is discussed in this tutorial.

Posted in: ATOTW > Paediatric Anaesthesia 2017 Language: english

Minimally invasive interventions in the cardiac catheterisation laboratory are now routine in the management of children with congenital heart disease. The majority of the procedure requires the child to be anaesthetised. This tutorial discusses the general principles, specific situations, associated complications and highlights the importance of vigilance and effective communication in management of these cases.

Posted in: ATOTW > Patient Safety & General Topics 2017 Language: english

An update on learning from recent anaesthesia-related patient safety incidents reported in the UK. This tutorial covers three areas featured in these reports: safe neuraxial blockade, drug errors and never events.

There can be few more challenging scenarios for non-paediatric intensive care teams than the initial management and stabilisation of a sick neonate. This article is Part 2 of the tutorial series and it expands on the specific management of each of the four most common conditions responsible for causing neonatal collapse.

There can be few more challenging scenarios for non-paediatric intensive care teams than the initial management and stabilisation of a sick neonate. The 2 articles in this series will provide practical advice for doctors and nurses from adult critical care, anaesthesia, paediatric and emergency medicine backgrounds. The first part of the series focuses on recognition and initial management of neonatal collapse.

Posted in: ATOTW > Patient Safety & Professional Wellbeing 2017 Language: english

Anaesthesiologists’ mental health is commonly overlooked and disregarded. Ensuring favourable professional well-being requires awareness, recognition and dedication for cultivating a healthy mindset. This tutorial discusses occupational related stress in anaesthesia, associated risk factors, coping capacities, individual and organisational initiatives to safeguard professional well-being.

Posted in: ATOTW > General Topics 2017 Language: english

An airway fire can be defined as a fire that occurs within a patient’s airway or that which involves an in-situ airway device or contiguous breathing circuit. Though uncommon event since the discontinuation of older more flammable anaesthetic agents, they are nonetheless associated with potentially devastating patient morbidity and mortality. An awareness of its risk factors is important for anesthesia providers in order to minimize its occurrence and to provide prompt and effective treatment should it arise.

Posted in: ATOTW > Paediatric Anaesthesia 2017 Language: english

Prolonged fasting in children, especially infants can result in dehydration, hypoglycaemia, hypovolaemia, hypotension, and other metabolic complications. A lot of debate in the recent years has risen about the usefulness of prolonged periods of fasting. Ideally children should not be starved for longer than absolutely necessary. This article explores the new guidelines surrounding this issue.

Posted in: ATOTW > General Topics 2017 Language: english

Bone Cement Implantation Syndrome (BCIS) is a potentially fatal complication of orthopaedic surgery involving pressurised bone cement. This tutorial describes the clinical features and classification of BCIS, along with its incidence and proposed pathophysiological mechanisms. It also covers the prevention, recognition and management of BCIS, which is important for every anaesthesia provider.

This tutorial discusses the feasibility of neuraxial anesthesia in a parturient with scoliosis or previous spinal surgery with emphasis on the challenges, practical tips as well as alternative approaches to labor analgesia.

Posted in: ATOTW > Regional Anaesthesia 2017 Language: english

Ultrasound is a favourite tool of the anaesthetist, but is seldom used in neuraxial anaesthesia. This tutorial aims to enlighten the reader; show the evidence behind neuraxial ultrasound, and guide them through the process of performing ultrasound guided neuraxial blocks, so they may consider integrating it into their own practice.

Posted in: ATOTW > Cardiothoracic Anaesthesia 2017 Language: english

Minimally invasive aortic valve replacement using transcatheter techniques has become commonplace in health centre’s worldwide. As experience of the technique and valve technology rapidly progress anaesthesiologists are increasingly required to help facilitate safe care in hybrid operating theatres. This tutorial aims to provide a summary on the perioperative management of patients for this procedure.

Posted in: ATOTW > Pain & General Topics 2017 Language: english

Intrathecal opioids provide effective analgesia for a variety of surgical procedures. This tutorial provides an overview of the clinical indications, complications and recommendations on their safe and effective use.

Posted in: ATOTW > Regional Anaesthesia 2017 Language: english

PECS blocks are regional fascial blocks that block the pectoral and intercostal nerves and provides analgesia for breast surgery and other procedures involving the thoracic wall. This tutorial covers the anatomy, technique and tips for performing PECS blocks.

Posted in: ATOTW > Obstetric Anaesthesia 2017 Language: english

Management of pregnant women with haemoglobinopathies and thrombophilia disorders can be challenging. This tutorial provides an overview of clinical presentation and key elements of anaesthetic management of these patients.

Posted in: ATOTW > General Topics & Patient Safety 2016 Language: english

An update on learning from recent anaesthesia-related patient safety incidents reported in the UK. This tutorial covers three areas featured in these reports: complications of vascular access, local anaesthetic systemic toxicity, and anaphylaxis.

Posted in: ATOTW > Intensive Care Medicine & General Topics 2016 Language: english

Accurate risk prediction allows identification of high risk patients and improves decision making including allocation of critical care resources. This article below describes both surgery and patient specific risk stratification tools and their applicability and limitations.

The applications of remifentanil for anaesthesia and intensive care medicine are rapidly expanding. In this tutorial we discuss these applications and the properties of remifentanil that make it so versatile. Considerations for the safe use of remifentanil are also covered as well as the Minto model for target controlled infusions.