Anaesthesia is the official journal of the Association of Anaesthetists of Great Britain and Ireland. It is a peer-reviewed medical journal and is published monthly.
The present editor-in-chief is Dr David Bogod.
The American Society of Anesthesiologists (ASA) is an association of physicians (primarily anesthesiologists) whose goal is to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.
Founded in 1905 as Long Island Society of Anesthetists by a group of nine colleagues meeting in the Long Island College Hospital, the society changed its name to New York Society of Anesthetists in 1911. In 1935 the society became known as American Society of Anesthetists and moved into rent-free accommodation in the E. R. Squibb & Sons building in New York City, shared with Wood Library-Museum of Anesthesiology. The association assumed its current in 1945 and moved its headquarters to Chicago in 1947. The society later moved to its current location of Park Ridge, Illinois, constructing purpose-built offices in 1960 and 1992. It now maintains a second office in Washington, D.C. to house its Office of Governmental and Legal Affairs.
As of 2008 the organization has over 43,000 members and 85 full time employees.
The incidence of life-threatening hypersensitivity reactions occurring during anaesthesia is around one in 10,000 procedures. Muscle relaxants are involved in over two thirds of the cases. Antibiotic administration is a frequent cause.
The mortality rate from these reactions is about 3-6%.
Successful immediate treatment requires prompt recognition by the attending anaesthetist. Adrenaline (epinephrine) remains the mainstay of treatment, with corticosteroids and antihistamines providing limited benefit in the acute situation.
Subsequent investigation aims to determine the responsible agent to allow its future avoidance. Skin testing is often useful to identify potentially cross-reactive compounds and appropriate therapeutic alternatives. This is done weeks after the initial reaction to allow the immune system to reset itself. However, skin testing can be misleading in giving false positive and false negative results.
There are a variety of artificial airways which can be used to keep a pathway between the lungs and mouth/nose. The most commonly used in long term or critical care situations is the endotracheal tube, a plastic tube which is inserted through the mouth and into the trachea, often with a cuff which is inflated to seal off the trachea and prevent any vomit being aspirated into the lungs. In some cases. a laryngeal mask airway (LMA) is a suitable alternative to an endotracheal tube, and has the advantage of requiring a lower level of training that an ET tube.
In the case of a choking patient, laryngoscopy or even bronchoscopy may be performed in order to visualise and remove the blockage.
An oropharyngeal airway or nasopharyngeal airway can be used to prevent the tongue from blocking the airway. When these airways are inserted properly, the rescuer does not need to manually open the airway with a head tilt/chin lift or jaw-thrust maneuver. Aspiration of blood, vomitus, and other fluids can still occur with these two adjuncts.
In the case of a patient who vomits or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. A unconscious patient who is regurgitating stomach contents should be turned into the recovery position when there is no suction equipment available, as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea.
The jaw thrust is a technique used on patients with a suspected spinal injury and is used on a supine patient. The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards - only possible on a patient with a GCS < 8 (although patients with a GCS higher than this should also be maintaining their own patent airway). When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.
ILCOR no longer advocates use of the jaw thrust by lay rescuers,[1] even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims.
Head tilt/Chin lift
The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most first aid courses as the standard way of clearing an airway
In cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:
there is an open pathway between a patient’s lungs and the outside world, and
the lungs are safe from aspiration.
In nearly all circumstances airway management is the highest priority for clinical care. This is because if there is no airway, there can be no breathing, hence no oxygenation of blood and therefore circulation (and hence all the other vital body processes) will soon cease. Getting oxygen to the lungs is the first step in almost all clinical treatments. The ‘A’ is for ‘airway’ in the ‘ABC’ of cardiopulmonary resuscitation.
Acta Anaesthesiologica Scandinavica is an internationally renowned peer-reviewed medical journal within the field of anaesthesia, intensive care, pain and emergency medicine, published in the English language.
It was established in 1957, and is the official publication of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. The present editor-in-chief is Sven Erik Gisvold.
Advanced Trauma Life Support (ATLS) was developed in the United States by the American College of Surgeons as a training programme for doctors in the management of acute trauma cases.
Definitive Surgical Trauma Skills course (DSTS) is a joint development between The Royal College of Surgeons of England, The Royal Centre for Defence Medicine and The Uniformed Services University of the Health Sciences, based in Maryland, USA. Originally designed for the military, the training structure was adapted to accommodate civilian surgical consultants and teaches vascular, cardiothoracic and general surgery techniques.