Current Anaesthesia & Critical Care RSS feed: Current Issue. In the fields of anaesthesia and critical care, ways of thinking can change so quickly that most textbooks have difficulty keeping up. This is not a problem for Current Anaesthesia & Critical Care . Published bi-monthly, each issue gives you access to the most current and vital account of what's going on in these critical areas. Self-assessment questions are a regular feature helping you test your knowledge. These are invaluable both for trainees preparing for examinations and the specialist undertaking CME. Each issue contains invited reviews written by highly regarded international experts on a variety of topics within the following areas: • Medicine • Physics and monitoring • Pharmacology • Practical procedures • Equipment • Controversies Current Anaesthesia & Critical Care is an effective continuous rolling textbook addressing the latest developments from a truly international perspective. The journal offers the trainee anaesthetist preparing for exams, and the established specialist, an authoritative collection of up-to-date views, findings and trends. Electronic usage: An increasing number of readers access the Journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information.http://www.currentanaesthesia.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Current Anaesthesia & Critical Care0953-7112214August 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.currentanaesthesia.com/article/PIIS0953711210000694/abstract?rss=yesEditorial Board & Aims and Scope10.1016/S0953-7112(10)00069-4Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7IFCIFChttp://www.currentanaesthesia.com/article/PIIS0953711210000633/abstract?rss=yesNot surprisingly anaesthesia for ophthalmic surgery has undergone very major changes over the previous two centuries. The discovery of local anaesthetic agents facilitated ophthalmic surgery and in due course general anaesthesia followed and to a great extent replaced local anaesthesia techniques. Local anaesthesia re-emerged and gained popularity towards the end of last century and is continuing to progress and grow in both applications and popularity.Ophthalmic anaesthesia in the 21st centuryChandra M. Kumar10.1016/j.cacc.2010.03.007Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia157157http://www.currentanaesthesia.com/article/PIIS0953711210000608/abstract?rss=yesSummary: Many patients undergoing ophthalmic surgery have significant co-morbidity. Many take anticoagulant or antiplatelet drugs. Stopping these drugs in patients with heart or vascular disease may result in death from a thromboembolic episode. The risk of this must be balanced against the risk of bleeding. In general, the risks of stopping these drugs outweigh the risks of ophthalmic surgery, which is in most cases confined to the eye. The majority of eye surgery is now performed under local anaesthesia (LA). There is no strong evidence currently to favour blunt cannula techniques such as sub-Tenon’s block over traditional sharp needle peribulbar block in patients on anticoagulant or antiplatelet therapy. Most studies are too small to detect a significant difference when comparing patients on anticoagulant or antiplatelet medication with those that are not, but the incidence of significant sight threatening haemorrhagic complications appears to be very low for cataract surgery, of the order of 3 per 10,000 operations.There is some concern that drug and food interactions may affect anticoagulation with warfarin and it is recommended that the International Normalized Ratio (INR) be measured as close to the time of operation as possible.Conclusions reached for ambulatory cataract surgery may not apply to more invasive and complex operations.Loco-regional anaesthesia for ocular surgery: Anticoagulant and antiplatelet drugsStephen J. Mather, K.-L. Kong, Shashi B. Vohra10.1016/j.cacc.2010.02.011Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia158163http://www.currentanaesthesia.com/article/PIIS0953711210000578/abstract?rss=yesSummary: Needle-based anaesthetic techniques were described in the nineteenth century and since have undergone many changes. Although the use of needle-based blocks has declined due to their complications and the emergence of safer alternative methods of local anaesthesia, they remain very popular in many countries. This review article describes the evidence based use of needle ophthalmic blocks for modern ophthalmic surgery.Needle blocks for modern ophthalmic surgeryChandra M. Kumar10.1016/j.cacc.2010.03.004Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia164167http://www.currentanaesthesia.com/article/PIIS0953711210000669/abstract?rss=yesSummary: Glaucomatous eyes are at heightened risk of optic nerve damage from local anaesthesia, and this may cause ‘wipe-out’ of vision. Most glaucoma surgery is done on the anterior part of the globe, and can be performed using any of the standard anaesthesia techniques. However, many surgeons prefer to avoid putting any LA near to the optic nerve, and simply anaesthetise the surgical area. Options include sub-conjunctival, sub-Tenon’s, or topical anaesthesia.Glaucoma patients may, of course, have surgery for other reasons. The anaesthesiologist needs to be familiar with the systemic side-effects and interactions of glaucoma medications.Acute rise in intra-ocular pressure may occur in predisposed eyes, and this can be sight-threatening. Acute angle closure glaucoma is discussed, along with a 3-step method to identify patients at risk. Patients who have recently had an intra-ocular gas bubble (with vitrectomy surgery) are at risk of blindness if they have a general anaesthesia with nitrous oxide, in the weeks before the bubble has dissolved.Anaesthesia for glaucoma surgeryTom Eke10.1016/j.cacc.2010.04.003Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia168173http://www.currentanaesthesia.com/article/PIIS0953711210000153/abstract?rss=yesSummary: Many patients presenting for V-R surgery are elderly with a high incidence of associated medical conditions. Thorough preoperative assessment is essential especially for those scheduled for general anaesthesia.Patients on anticoagulants and antiplatelet drugs scheduled for V-R surgery should continue their routine medication. However, where there are specific concerns, the anaesthetist, surgeon and patient should discuss the risks and benefits of continuing their routine medication to agree an acceptable approach.Local anaesthetic techniques are now far more commonly used than general anaesthesia for V-R surgery. Clinicians must recognize the limitations and contraindications of both approaches.Whenever local anaesthetic techniques are used, attention to small details can make a huge difference to patient comfort. This often entails meticulous patient positioning and clear lines of communication between patient and the theatre team. Sometimes, sedative drugs are beneficial to patient care.Careful patient monitoring is recommended during V-R surgery because of the darkened theatre environment, the age and associated medical conditions of many of these patients, and the risk of precipitating abnormal cardiac rhythms from drugs and the oculocardiac reflex.Anaesthesia for vitreo-retinal surgeryK.L. Kong, Graham Kirkby10.1016/j.cacc.2009.11.008Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia174179http://www.currentanaesthesia.com/article/PIIS0953711210000591/abstract?rss=yesSummary: Excessive tearing due to obstruction of the nasolacrimal duct is a common ophthalmic problem. Dacryocystorhinostomy (DCR) is the procedure designed to treat primary or secondary adult anatomical obstruction. External DCR is the traditional surgical approach, however endoscopic DCR can be done. In the past, general anaesthesia (GA) has been considered as the gold standard for DCR surgery; endotracheal intubation and throat pack offer an important function as protective mechanisms of the patient’s airway against blood aspiration. Head up position, hypotensive anaesthesia, incision infiltration with lidocaine/epinephrine together with insertion of nasal pack soaked in decongestant solution are a routine measures to guard against intraoperative bleeding that may hinder surgical site visualization. Increase awareness of regional anaesthesia efficacy contemplated the surgeons towards the use of such techniques. The basic concept of local anaesthesia for DCR involves blockade of infratrochlear, infraorbital and anterior ethmoidal nerves either by separate injections or by local infiltration along with intranasal preparation. It has been found that DCR under regional anaesthesia minimizes intraoperative bleeding, inpatient stay and reduce health care expenditure. Further, many patients prefer regional anaesthesia due to less postoperative pain. These benefits are desirable particularly in elderly population in whom GA constitute a threat for their life.Anaesthesia for dacryocystorhinostomyWaleed Riad, Imtiaz A. Chaudhry10.1016/j.cacc.2010.02.010Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia180183http://www.currentanaesthesia.com/article/PIIS0953711210000670/abstract?rss=yesSummary: Controversies exist regarding optimal anesthetic management of patients receiving surgery for ocular trauma. Ocular injuries are commonly encountered in clinical practice as an estimated 750,000 patients are hospitalized with eye injuries annually throughout the world. Many, particularly those with open globe injuries, require surgery, often under emergency conditions that make the patient’s anesthetic management challenging. This paper reviews epidemiological data illustrating the prevalence and incidence of serious eye injuries and then presents a case study detailing the anesthetic management of a severely traumatized patient to illustrate a discussion of current options and recommendations for the management of such cases.Anesthesia for ocular traumaAshish C. Sinha, Brian Baumann10.1016/j.cacc.2010.05.001Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia184188http://www.currentanaesthesia.com/article/PIIS095371121000061X/abstract?rss=yesSummary: Subjective visual perceptions during intraocular ophthalmic surgery under regional anaesthesia are now well recognised. They range from simple light perception to seeing vivid colours, intricate movements, flashes and instruments. Surgeons, anaesthetists and patients should be aware of these phenomena. Although the majority of the patients find visual perceptions bearable some may be frightened. Preoperative counselling should therefore be offered to patients. This article reviews the range and clinical implications of subjective visual perceptions during intraocular surgery and explores the mechanisms behind their genesis.Subjective visual perceptions during intraocular surgery under local anaesthesia: a reviewShashi B. Vohra, Chandra M. Kumar, Philip I. Murray10.1016/j.cacc.2010.02.012Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia189195http://www.currentanaesthesia.com/article/PIIS095371121000058X/abstract?rss=yesSummary: An anaesthetic presence is often questioned in operations that can be performed under topical anaesthesia. However, the anaesthetist role extends far beyond providing general anaesthesia. They can provide sedation if required, have the ability to perform different regional blocks, and to treat both acute and chronic orbital pain conditions. Of as great importance is that anaesthetists routinely monitor patients under a wide range of anaesthetics and are able to identify and manage serious life threatening complications if they happen perioperatively.The role of the anaesthetist in ophthalmic surgery in the 21st centuryEzzat Samy Aziz10.1016/j.cacc.2010.03.005Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia196198http://www.currentanaesthesia.com/article/PIIS0953711210000621/abstract?rss=yesSummary: The adaptation of videotechnology for laryngoscopy appears to be an interesting and promising option in the field of airway management. The place of videolaryngoscope-assisted intubation in airway management has yet to be determined. This article will aim to describe the technique of videolaryngoscopy, discuss the videolaryngoscopes that are currently available and give a summary of the available evidence for their use.VideolaryngoscopyAnjum Ahmed-Nusrath10.1016/j.cacc.2010.03.006Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Focus on: Ophthalmic Anaesthesia199205http://www.currentanaesthesia.com/article/PIIS0953711210000645/abstract?rss=yes Excessive tearing could be due to:Continuing Professional Development: Ophthalmic MCQs and self-assessment questionsChandra M. Kumar10.1016/j.cacc.2010.04.001Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Continuing Professional Development206208http://www.currentanaesthesia.com/article/PIIS0953711210000657/abstract?rss=yes Excessive tearing could be due to: A, B, C, EContinuing Professional Development: Ophthalmic MCQs and self-assessment answersChandra M. Kumar10.1016/j.cacc.2010.04.002Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Continuing Professional Development209212http://www.currentanaesthesia.com/article/PIIS0953711210000554/abstract?rss=yesRoopa et al. have described a case of atypical HELLP syndrome, presenting as bleeding from the epidural puncture site. Their prompt investigation of this bleeding revealed HELLP syndrome, but this diagnosis could have been significantly delayed because of the absence of hypertension and significant proteinuria. Although described as atypical, this case is typical in the subtlety of presenting signs and symptoms followed by rapid development of multisystem problems including post partum haemorrhage, disseminated intravascular coagulation (DIC), pulmonary oedema, and renal dysfunction. The supportive management that Roopa et al. subsequently employed successfully prevented permanent morbidity or mortality. Their case report and review of HELLP syndrome is a most useful reminder to us all about this challenging condition.A case of atypical HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome presenting as bleeding from the epidural puncture site during labour – CommentaryMartin Dresner10.1016/j.cacc.2010.03.002Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Commentary: Obstetrics213213http://www.currentanaesthesia.com/article/PIIS0953711210000414/abstract?rss=yesIn 1858 Gray and Carter published the first edition of this wonderful textbook. The new one is the 40th edition and the 150 year anniversary edition. I have a well used old copy of Grays anatomy which was, curiously, also an Anniversary edition. It is a large book with very small print and crowded diagrams printed on fine but expensive paper. Looking something up was always hard even when ones eyesight was good but now requires a bright light and reading glasses. There was always a sense of achievement in finding the answer to a question. It is the gold standard though there are a host of easier to read books around. Well anatomy does not change so when I was asked to review the latest edition I expected much the same.Gray's anatomy – the anatomical basis of clinical practice, expert consultNeil Soni10.1016/j.cacc.2010.03.001Current Anaesthesia & Critical Care 21, 4 (2010)2010-08-01Current Anaesthesia & Critical Care2010-08-01214S0953-7112(10)X0004-7Book Review214214