Recent Advances in Anaesthesia and Intensive Care 22 PDF
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In 1932 J & A Churchill Ltd published the first edition of Recent Advances in Anaesthesia and Analgesia (Including Oxygen Therapy). Nearly 70 years later we commented in the Preface to the Millennium (21st) edition of Recent Advances in Anaesthesia and Analgesia that the pace of advances in anaesthesia showed no sign of abating. Although 2 years further on this statement remains true, change has now affected the title as well. Harcourt Publishers Ltd has transferred the title from Churchill Livingstone to Greenwich Medical Media Ltd. Coincident with the transfer it was decided to include more Intensive Care Medicine topics and consequently the title has been changed to Recent Advances in Anaesthesia and Intensive Care. In association with this change, we are pleased that Dr Michael Grounds has joined the editorial team.
The range of topics covered in this issue represent all aspects of anaesthesia from basic science to clinical practice, from training the anaesthetists of the future to relevant medical conditions, from optimization of patients to resuscitation of patients. As always, the editors are grateful to the many distinguished colleagues who have contributed to Recent Advances in Anaesthesia and Intensive Care – 22. The first three chapters present developments in pharmacology. It is now appreciated that there are two related, but unique isoforms, of the cyclo-oxygenase (COX) enzyme, which play important but different physiological and pathophysiological roles. An understanding of the differences between COX-1 and COX-2 is necessary for the logical development of new anti-inflammatory drugs. In their chapter on The COX Enzyme System, Dr Bishop-Bailey and Prof. Warner clearly elucidate these differences and their significance. Over recent years, drug stereochemistry has become a topic of considerable interest, with much discussion on the relative merits of using single isomer versus racemic mixtures of chiral drugs. Advances in chiral technology permit the commercial synthesis of singleisomer compounds. Dr Hutt considers the relevance of drug chirality to anaesthesia. With all of this interest in drug stereochemistry it is probably no surprise that chirality has been important in the development of new local anaesthetic agents. In his chapter on New Local Anaesthetics, Dr McLeod describes in detail recent advances in molecular biology with respect to nerve conduction as well as concepts of the method of action of local anaesthetics; he discusses both levobupivacaine and ropivacaine in detail.
The prevalence of asthma in society has increased dramatically over the past 30 years and at the same time the death rate has also been increasing alarmingly. Drs Cormican and Rees suggest that the reasons for the increase in the prevalence of atopy are still poorly understood, although a number of explanations have been proposed. They describe current understanding with regard to the epidemiology, genetics and immunopathology of asthma as well as discussing the implication of asthma for anaesthetists. In his chapter on reducing mortality and complications in high-risk surgical patients, Dr Grounds emphasizes that over the last quarter of a century the incidence of death following surgery, that is directly attributable to anaesthesia, has fallen. He suggests that deaths and complications after operation can nevertheless be reduced further in high-risk patients by the implementation of early aggressive goal-directed therapy aimed at temporarily improving the cardiovascular performance of these patients.
In the next chapter on an intensive care medicine topic, Prof. Gattinoni with Drs Chiumello and Pelosi argue the merits of prone position lung ventilation in patients with acute lung injury or the adult respiratory distress syndrome. They review the pathophysiology related to the prone position, the mechanisms for improving gas exchange and the existing clinical data on the use of prone position ventilation in patients with this spectrum of lung damage. Antibiotic resistance is a source of increasing concern, particularly among patients in the intensive care unit. In their chapter on Antibiotics and Nosocomial Infection in the Intensive Care Unit, Prof. Chastre and Dr Trouillet point out that the excess hospital costs due to antimicrobial resistance may reach tens of billions of dollars a year in the United States of America. They discuss the root cause of the problem and the core issues and suggest that apparently adequate control strategies are unlikely to succeed without clear strategic objectives.
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recent advances in anaesthesia and intensive care
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recent advances in anaesthesia and intensive care pdf