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Posted in: ATOTW > General Topics 2018 Language: english

A review of the evidence and utility of ketamine. This includes discussion of its role as an anaesthetic and analgesic drug for use in the pre-hospital environment, emergency department, operating theatre and critical care unit.

Posted in: ATOTW > Obstetric Anaesthesia 2018 Language: english

Intraoperative cell salvage in obstetrics is a safe adjunct or alternative treatment to allogenic blood transfusions during a postpartum hemorrhage. This tutorial will describe how the cell salvage circuit works and review the indications, contraindications, advantages, disadvantages and risks of intraoperative cell salvage in obstetrics.

Posted in: ATOTW > Intensive Care Medicine 2018 Language: english

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery as an effective multimodality treatment option for selected patients with peritoneal surface malignancies. This tutorial discusses the anaesthetic considerations and physiological impacts of the procedure.

Posted in: ATOTW > Patient Safety 2018 Language: english

This case report describes a number of risk factors that are associated with potential deformation or fracture of spinal needles during subarachnoid anaesthesia, followed by some practical tips on how to avoid this complication and how to deal with it if it occurs.

Posted in: ATOTW > General Topics & Intensive Care Medicine 2018 Language: english

This tutorial aims to provide the reader with a framework for approaching the complex physiologic changes and challenges of liver transplant anesthesiology. After reading this article the reader should be able to understand the common perioperative issues surrounding the patient with liver failure and recognize that outcomes are dependent on a multidisciplinary approach to management.

Posted in: ATOTW > Regional Anaesthesia & Pain 2018 Language: english

This tutorial covers ultrasound-guided paravertebral nerve block. It discusses the basic anatomy, indications and complications associated with this peripheral regional anaesthesia. The article goes into detail the preparation required to carry out this block and discusses 3 common ultrasound-guided approaches that can be utilized.

Posted in: ATOTW > General Topics 2018 Language: english

This article highlights factors that make patients at high risk of perioperative myocardial ischaemia. It also discusses evidence for anaesthetic technique for this high-risk group and the management of intra-operative myocardial ischaemia.

Posted in: ATOTW > Patient Safety 2018 Language: english

This tutorial is based on learning from incidents reported to the National Health Service England and Wales National Reporting and Learning System, and covers infusion safety, preoperative assessment and bone cement implantation syndrome.

Posted in: ATOTW > Cardiothoracic Anaesthesia 2018 Language: english

This tutorial describes the conduct of Deep Hypothermic Circulatory Arrest and its relevance to the anaesthetist, using the latest available evidence. The concept of therapeutic hypothermia, options for intraoperative monitoring and the different neuroprotective strategies are discussed.

Posted in: ATOTW > Intensive Care Medicine 2018 Language: english

Liberation from mechanical ventilation and the artificial airway support in the intensive care unit is difficult and challenging. Success hinges on the perfect blend of art and science. An algorithmic evidence based approach along with a very strong clinical acumen is possibly the best recipe for success. This tutorial attempts to summarise the currently accepted guidelines in this area.

Posted in: ATOTW > General Topics 2018 Language: english

Surgery for metastatic spinal disease is an expanding discipline with an ever increasing patient demand. This tutorial aims to cover anaesthetic considerations related to metastatic spinal disease surgery including airway management, prone positioning, massive haemorrhage, chemotherapy considerations and complex analgesia.

Posted in: ATOTW > Pain 2018 Language: english

Buprenorphine/naloxone (i.e. Suboxone®, Zubsolv®, Bunavail®) is an increasingly popular evidence-based therapy for opioid use disorder. This tutorial describes its unique pharmacology, the challenges it poses to anesthetic management and the strategies for providing perioperative analgesia to patients on buprenorphine/naloxone.

Posted in: ATOTW > Regional Anaesthesia > Anaesthesia 2017 Language: english

In this tutorial, the classical anatomy of the brachial plexus will be described. Anatomical variations of the brachial plexus will be subsequently explored and the associated clinical implications for the anaesthetist discussed.

Posted in: ATOTW > Paediatric Anaesthesia 2017 Language: english

This tutorial provides a review of the common causes of acute airway obstruction in children. It also discusses how children may be assessed and managed in this emergency situation.

Posted in: ATOTW > Paediatric Anaesthesia 2017 Language: english

This tutorial will explore six common challenges that arise at induction of anaesthesia when looking after a paediatric patient. Anxiety, behavioural problems, the need for restraint, difficult IV access, the full stomach and co-morbidities add complexity and can make the art of maintaining a calm and smooth induction difficult.

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.