Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku044
A Feizerfan FRCA, Sheh G BHB MBChB FAFRM(RACP) FFPMANZCA
{"title":"Transition from acute to chronic pain","authors":"A Feizerfan FRCA, Sheh G BHB MBChB FAFRM(RACP) FFPMANZCA","doi":"10.1093/bjaceaccp/mku044","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku044","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91717378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU013
Sarah Griffiths, Jeremy P Campbell
In the late 1950s and early 1960s, the devastating series of thalidomide-induced birth defects raised awareness of the imperfect state of the placenta as a barrier to drug transfer. Subsequent research has sought to elucidate the precise nature and mechanisms of transplacental drug passage. There has also been increasing interest in the deliberate use of maternally administered drugs designed to cross the placenta and provide therapeutic effects on the fetus. This article reviews the structure and key functions of the placenta. It also summarizes our current understanding of placental drug transfer, particularly of drugs used for anaesthesia and analgesia in pregnancy.
{"title":"Placental structure, function and drug transfer","authors":"Sarah Griffiths, Jeremy P Campbell","doi":"10.1093/BJACEACCP/MKU013","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU013","url":null,"abstract":"In the late 1950s and early 1960s, the devastating series of thalidomide-induced birth defects raised awareness of the imperfect state of the placenta as a barrier to drug transfer. Subsequent research has sought to elucidate the precise nature and mechanisms of transplacental drug passage. There has also been increasing interest in the deliberate use of maternally administered drugs designed to cross the placenta and provide therapeutic effects on the fetus. This article reviews the structure and key functions of the placenta. It also summarizes our current understanding of placental drug transfer, particularly of drugs used for anaesthesia and analgesia in pregnancy.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81443512","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}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU044
A. Feizerfan, G. Sheh
Pain is commonly classified into acute and chronic. Acute pain implies a painful condition with a rapid onset or of a short course whereas chronic pain is referred to as a painful condition persisting beyond the normal time of healing. Transition of acute pain to chronic pain is an observed entity associated with enormous burden on the healthcare system. Minimization of this transition has been a challenge for decades. Numerous studies have investigated different factors that increase susceptibility in transition of acute to chronic pain. This article focuses on the basic science and pathophysiological changes during pain processing and clinical modalities aiming to minimize the risk of transition from acute to chronic pain.
{"title":"Transition from acute to chronic pain","authors":"A. Feizerfan, G. Sheh","doi":"10.1093/BJACEACCP/MKU044","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU044","url":null,"abstract":"Pain is commonly classified into acute and chronic. Acute pain implies a painful condition with a rapid onset or of a short course whereas chronic pain is referred to as a painful condition persisting beyond the normal time of healing. Transition of acute pain to chronic pain is an observed entity associated with enormous burden on the healthcare system. Minimization of this transition has been a challenge for decades. Numerous studies have investigated different factors that increase susceptibility in transition of acute to chronic pain. This article focuses on the basic science and pathophysiological changes during pain processing and clinical modalities aiming to minimize the risk of transition from acute to chronic pain.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76891755","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}
Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku018
Stewart Alexander Michael BSc(Hons) MPhil MRCP, Greaves Kim BSc MD FACC FRCP, Bromilow James BM MRCP FRCA FFICM
{"title":"Supraventricular tachyarrhythmias and their management in the perioperative period","authors":"Stewart Alexander Michael BSc(Hons) MPhil MRCP, Greaves Kim BSc MD FACC FRCP, Bromilow James BM MRCP FRCA FFICM","doi":"10.1093/bjaceaccp/mku018","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku018","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91717381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku015
Leslie David BSc (Hons) MBBCh (Hons) FRCA, Stacey Mark MB MChir FRCA ILTHE MSc (Med Ed)
A middle-aged ASA II patient with obstructive sleep apnoea and a BMI of 35 kg.m required a total thyroidectomy. The patient had limited cervical spine mobility, tracheal deviation and it was noted that a surgical airway would be difficult. A spontaneously breathing general anaesthetic was performed using propofol and remifentanil. Direct laryngoscopy showed a grade 3 view and during repositioning complete airway obstruction followed with inability to mask ventilate despite six-handed ventilation. Several unsuccessful attempts at needle cricothyroidotomy, both fine and large bore, were made and the airway was finally secured after a difficult tracheostomy. The patient spent 20 minutes with oxygen saturations of less than 50% and received elective ventilation to manage cerebral hypoxia. A full recovery was reported. NAP4—Major Complications of Airway Management in the UK.
{"title":"Awake intubation","authors":"Leslie David BSc (Hons) MBBCh (Hons) FRCA, Stacey Mark MB MChir FRCA ILTHE MSc (Med Ed)","doi":"10.1093/bjaceaccp/mku015","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku015","url":null,"abstract":"A middle-aged ASA II patient with obstructive sleep apnoea and a BMI of 35 kg.m required a total thyroidectomy. The patient had limited cervical spine mobility, tracheal deviation and it was noted that a surgical airway would be difficult. A spontaneously breathing general anaesthetic was performed using propofol and remifentanil. Direct laryngoscopy showed a grade 3 view and during repositioning complete airway obstruction followed with inability to mask ventilate despite six-handed ventilation. Several unsuccessful attempts at needle cricothyroidotomy, both fine and large bore, were made and the airway was finally secured after a difficult tracheostomy. The patient spent 20 minutes with oxygen saturations of less than 50% and received elective ventilation to manage cerebral hypoxia. A full recovery was reported. NAP4—Major Complications of Airway Management in the UK.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90025762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/bjaceaccp/mku013
Griffiths Sarah K BMedSci (Hons) BM BS FRCA, Campbell Jeremy P MBChB (Hons) MRCS FRCA
{"title":"Placental structure, function and drug transfer","authors":"Griffiths Sarah K BMedSci (Hons) BM BS FRCA, Campbell Jeremy P MBChB (Hons) MRCS FRCA","doi":"10.1093/bjaceaccp/mku013","DOIUrl":"https://doi.org/10.1093/bjaceaccp/mku013","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-04-01DOI: 10.1093/BJACEACCP/MKU012
J. Scott-Warren, A. Bhaskar
The WHO analgesic ladder, with its emphasis on ‘by the clock’ oral analgesia, forms a useful framework for the initial pharmacological management of patients with cancer pain. It is reported to be successful in 80–90% of patients. However, of the 10–20% of patients with pain that is poorly responsive to opioids, or where side-effects are particularly problematic, some may greatly benefit from invasive procedures designed to interrupt pain signals along neural pathways from periphery to the brain. It should be emphasized that such procedures should not be seen as the ‘4th step’ of the WHO analgesic ladder, but can and should be considered at each step depending on patient preference and need. There is opportunity to interrupt nocioceptive traffic at peripheral and central levels via destructive neuroablatory or non-destructive techniques. All interventions designed to relieve cancer pain carry attendant risk, and these must be weighed against potential benefits on a case-by-case basis. Overall, 8% of patients with cancer pain may require nerve blocks, 3% neurolytic blocks, and 3% neuraxial techniques.
{"title":"Cancer pain management: Part II: Interventional techniques","authors":"J. Scott-Warren, A. Bhaskar","doi":"10.1093/BJACEACCP/MKU012","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKU012","url":null,"abstract":"The WHO analgesic ladder, with its emphasis on ‘by the clock’ oral analgesia, forms a useful framework for the initial pharmacological management of patients with cancer pain. It is reported to be successful in 80–90% of patients. However, of the 10–20% of patients with pain that is poorly responsive to opioids, or where side-effects are particularly problematic, some may greatly benefit from invasive procedures designed to interrupt pain signals along neural pathways from periphery to the brain. It should be emphasized that such procedures should not be seen as the ‘4th step’ of the WHO analgesic ladder, but can and should be considered at each step depending on patient preference and need. There is opportunity to interrupt nocioceptive traffic at peripheral and central levels via destructive neuroablatory or non-destructive techniques. All interventions designed to relieve cancer pain carry attendant risk, and these must be weighed against potential benefits on a case-by-case basis. Overall, 8% of patients with cancer pain may require nerve blocks, 3% neurolytic blocks, and 3% neuraxial techniques.","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87483199","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}
Pub Date : 2015-02-01DOI: 10.1093/bjaceaccp/mku004
Diana Raj MB ChB MRCP FRCA, Luginbuehl Igor MD FMH
{"title":"Managing the difficult airway in the syndromic child","authors":"Diana Raj MB ChB MRCP FRCA, Luginbuehl Igor MD FMH","doi":"10.1093/bjaceaccp/mku004","DOIUrl":"10.1093/bjaceaccp/mku004","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mku004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78291880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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