Pub Date : 2014-02-01DOI: 10.1093/BJACEACCP/MKT033
A. Feizerfan, J. Antrobus
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Pub Date : 2014-02-01DOI: 10.1093/BJACEACCP/MKT030
L. Lynch
Anaesthetists have made use of the intrathecal (IT) space to provide optimum anaesthesia and analgesia for decades. Most commonly to tide the patient through the operative period, but also for postoperative pain relief. The advantages of the techniques and the comparative effectiveness of the drugs compared with other methods of administration are well known. Those of us who work in the field of chronic pain management are faced with providing relative analgesia over days and weeks for terminal cancer patients, months and years for those with progressive cancer-related pain and over decades for those with intractable pain of either malignant or non-malignant aetiology. We can do this to a great extent with the intrathecal drug delivery (ITDD) systems currently available. There are, of course, many treatment options available for patients with chronic pain and ITDD systems are by no means a first-line treatment, but in selected patients both can relieve pain and restore the quality of life in the short and long terms. It should be possible to relieve pain below the diaphragm with relative ease. Above the diaphragm, the effects of drugs on the cardio-vascular system may limit the use of effective doses of drugs. ITDD is an evolving therapy, and current drugs and practice may change in the light of new information.
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Pub Date : 2014-02-01DOI: 10.1093/bjaceaccp/mkt033
Alireza Feizerfan FRCA, JHL Antrobus FFPMRCA
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Pub Date : 2014-02-01DOI: 10.1093/bjaceaccp/mkt027
James I. Beck MBBS FRCA, Kevin D. Johnston MBChB(Hons) BDS BSc MFDS FRCA
{"title":"Anaesthesia for cosmetic and functional maxillofacial surgery","authors":"James I. Beck MBBS FRCA, Kevin D. Johnston MBChB(Hons) BDS BSc MFDS FRCA","doi":"10.1093/bjaceaccp/mkt027","DOIUrl":"10.1093/bjaceaccp/mkt027","url":null,"abstract":"","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"14 1","pages":"Pages 38-42"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/bjaceaccp/mkt027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78732859","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 : 2014-02-01DOI: 10.1093/BJACEACCP/MKT023
A. Lumb, Claire Biercamp
Chronic obstructive pulmonary disease (COPD) is a commonly encountered respiratory disorder. Patients with COPD pose a challenge to the anaesthetist because intraoperative and post- operative complications occur more commonly than in those without the disease, and can lead to prolonged hospital stay and increased mortality. This article provides an overview of COPD and discusses implications for the anaesthetic management of patients with the disease. Pathophysiology COPD is a chronic and progressive inflammatory condition affecting central and peripheral airways, lung parenchyma, and pulmonary vas- culature. This leads to poorly reversible narrow- ing of the airways, remodelling of airway smooth muscle, increased numbers of goblet cells and mucus-secreting glands, and pulmon- ary vasculature changes resulting in pulmonary hypertension. It is widely accepted that cigarette smoking is the key noxious stimulus leading to the devel- opment of COPD. However, more recently it has been suggested that genetic factors are also implicated, with the finding that a genetic variant (FAM13A) is associated with the devel- opment of COPD in the COPDGene study. 1 COPD is characterized by expiratory airflow limitation because of a combination of small airway inflammation (obstructive bronchiolitis) and parenchymal destruction (emphysema). In the former, inflammation in the small airways causes obstruction and air trapping, leading to dynamic hyperinflation, which adversely affects both ventilation/perfusion (V/Q) matching and the mechanics of the respiratory muscles. In em- physema the end result of inflammation is elastin breakdown and subsequent loss of alveolar structural integrity leading to decreased gas transfer, reduction in the pulmonary capillary bed, and further worsening of V/Q matching. Further airflow limitation results from reduced parenchymal support of small airways. Often it is not possible to make clear distinctions between the two subtypes and the relative contri- bution of each varies from patient to patient. In patients with advanced COPD, the combin- ation of V/Q mismatch, decreased gas transfer, and alveolar hypoventilation ultimately leads to respiratory failure. COPD is often associated with a number of coexisting diseases that may complicate the an- aesthetic management of these patients. A high proportion of patients with COPD are smokers, hence the disease is associated with the develop- ment of lung cancer. Pulmonary hypertension is prevalent in a third of patients with COPD and has been shown to be an indicator of poor long- term survival. Inflammatory processes in the lung not only cause pulmonary effects but also contribute to the extrapulmonary effects of the disease. The origin of this systemic inflamma- tion is unclear and probably multifactorial, but results in weight loss, skeletal muscle dysfunc- tion (with further adverse effects on respiratory muscle function), cardiovascular disease, de- pression, and osteoporosis. Weight
{"title":"Chronic obstructive pulmonary disease and anaesthesia","authors":"A. Lumb, Claire Biercamp","doi":"10.1093/BJACEACCP/MKT023","DOIUrl":"https://doi.org/10.1093/BJACEACCP/MKT023","url":null,"abstract":"Chronic obstructive pulmonary disease (COPD) is a commonly encountered respiratory disorder. Patients with COPD pose a challenge to the anaesthetist because intraoperative and post- operative complications occur more commonly than in those without the disease, and can lead to prolonged hospital stay and increased mortality. This article provides an overview of COPD and discusses implications for the anaesthetic management of patients with the disease. Pathophysiology COPD is a chronic and progressive inflammatory condition affecting central and peripheral airways, lung parenchyma, and pulmonary vas- culature. This leads to poorly reversible narrow- ing of the airways, remodelling of airway smooth muscle, increased numbers of goblet cells and mucus-secreting glands, and pulmon- ary vasculature changes resulting in pulmonary hypertension. It is widely accepted that cigarette smoking is the key noxious stimulus leading to the devel- opment of COPD. However, more recently it has been suggested that genetic factors are also implicated, with the finding that a genetic variant (FAM13A) is associated with the devel- opment of COPD in the COPDGene study. 1 COPD is characterized by expiratory airflow limitation because of a combination of small airway inflammation (obstructive bronchiolitis) and parenchymal destruction (emphysema). In the former, inflammation in the small airways causes obstruction and air trapping, leading to dynamic hyperinflation, which adversely affects both ventilation/perfusion (V/Q) matching and the mechanics of the respiratory muscles. In em- physema the end result of inflammation is elastin breakdown and subsequent loss of alveolar structural integrity leading to decreased gas transfer, reduction in the pulmonary capillary bed, and further worsening of V/Q matching. Further airflow limitation results from reduced parenchymal support of small airways. Often it is not possible to make clear distinctions between the two subtypes and the relative contri- bution of each varies from patient to patient. In patients with advanced COPD, the combin- ation of V/Q mismatch, decreased gas transfer, and alveolar hypoventilation ultimately leads to respiratory failure. COPD is often associated with a number of coexisting diseases that may complicate the an- aesthetic management of these patients. A high proportion of patients with COPD are smokers, hence the disease is associated with the develop- ment of lung cancer. Pulmonary hypertension is prevalent in a third of patients with COPD and has been shown to be an indicator of poor long- term survival. Inflammatory processes in the lung not only cause pulmonary effects but also contribute to the extrapulmonary effects of the disease. The origin of this systemic inflamma- tion is unclear and probably multifactorial, but results in weight loss, skeletal muscle dysfunc- tion (with further adverse effects on respiratory muscle function), cardiovascular disease, de- pression, and osteoporosis. Weight ","PeriodicalId":100332,"journal":{"name":"Continuing Education in Anaesthesia Critical Care & Pain","volume":"2 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75311085","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}
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