Chronic Pain: Atlas of Investigation and Management

Chronic Pain: Atlas of Investigation and Management

Chronic pain affects nearly one in every four adults worldwide, with pain one of the most common symptoms resulting in medical consultation. The increasing focus on chronic pain presents difficulties for the busy practitioner. Patients typically describe a complex pattern of discomfort, disability, and distress, with pain affecting physical, social, and psychological functioning. Clinicians must efficiently condense widely varied symptomatic descriptions into characteristic patterns to permit accurate diagnosis and implement effective treatment. This atlas serves as a useful educational resource for the healthcare provider by providing ready access to characteristic descriptions of common pain syndromes, patient photographs and imaging studies, and evidence-based data summaries from the latest research studies, all presented in easy-to-understand visual formats."Chronic Pain: an Atlas of Investigation and Management" offers a unique and broad-based perspective on the subject, drawing on the resources and extensive clinical experience of anesthesiology, internal medicine, neurology, oncology, and rheumatology. Pain assessment and management is comprehensively addressed by including common syndromes from most body regions and inclusion of medication, non-medication, and interventional therapy options for both nonmalignant and malignant chronic pain. An entire chapter focused on pain management tools for patients provides charting documentation aids and educational patient handouts to facilitate patients' understanding of their individual pain syndrome and a variety of pain management techniques. Extensive use of figures, algorithms, tables, and boxes, along with the patient educational materials, makes this book an invaluable chronic pain reference as well as a practical resource for daily clinical practice.

Clinical Cases in Anesthesia: 3rd Ed.

Clinical Cases in Anesthesia: 3rd Ed.
By Allan Reed, Francince Yudkowitz

Actual case studies in a Q & A format explore contemporary problems in anesthesia, and provide practical solutions based on a careful examination of all of the important scientific and clinical principles for each case. The 3rd Edition offers brand-new coverage of key topics in the cardiovascular, respiratory, central nervous system, abdomen, and post-anesthesia care sections as well as a completely new section on trauma. It also addresses important topics such as hemophilia, infant anesthesia, lower extremity anesthesia, and celiac plexus blocks. All of the existing cases are thoroughly revised to include new treatments and practice guidelines, and new knowledge of the relevant pharmacology. It’s an ideal review tool for board preparation, and a handy resource for practice.

* Offers solutions to frequently occurring practical problems through discussions of pathophysiology, pharmacology, preoperative evaluation, and intraoperative care.
* Facilitates the proper identification of both common and rare clinical problems.
* Examines the crucial scientific and clinical principles for each case study.

Pacing to Support the Failing Heart

Pacing to Support the Failing Heart (American Heart Association Clinical Series)

By Kenneth Ellenbogen, Angelo Auricchio

This new title in the American Heart Association Clinical Series offers an up-to-date overview of the causes and damage related to dyssynchronopathy - a new pathophysiological entity related to spontaneous or pacing induced mechanical abnormalities which causes heart failure. It presents the most recent diagnostic non-invasive tools and provides simple, practice-oriented therapeutic proposals for heart failure patients.

BJA: Volume 103 Number 5 November 2009

BJA: Volume 103 Number 5 November 2009

Thanks to an anonymous friend

In this issue.....
Local anaesthetic neurotoxicity
There is some concern that local anaesthetic (LA) agents may have neurotoxic effects which can lead to neurological damage following their use. Two laboratory studies in this month’s BJA contribute to our understanding of this problem. They have examined the cytotoxic effects by measuring cell death (apoptosis) on exposure to various concentrations of LA agents. Werdehausen et al. (pages 711–18) found evidence of early apoptotic actions on neuroblastoma cells for eight LA agents, including bupivacaine and lidocaine, which occurred in a concentration-dependent manner at clinically relevant concentrations. In a study using cultured rat astrocytes (Lee et al., pages 719–25), only tetracaine significantly increased cell death and the authors propose that this is related to oxidative stress.

New airway devices
There are a number of new airway devices currently being evaluated in clinical practice. Powell et al. (pages 755–60) compared the use four devices (Glidescopew, Bonfil, CTrachTM and Macintosh) by nonanaesthetists, trainees and consultant anaesthetists in a manikin set up of normal and difficult airway. They found that the Macintosh performed best overall and the Glidescopew was the most consistently successful of the others in all groups. In a study of 75 patients with potentially difficult intubation, Malik et al. (pages 761–8) found that the Glidescopew and AWSw reduced the difficulty of intubation compared with the Macintosh.

Dealing with critical information
The ability to deal with a mass of information from monitors during critical incidents is essential. Two different aspects of this are explored in this month’s journal. Davis et al. (pages 665–9) have assessed the mental workload in 10 trainee anaesthetists during a simulated crisis using a vibrotactile response device. They found that response times increased with increasing mental workload during the critical incident. The method of displaying vital clinical information on a monitor may be important in initiating an early response to a problem. Charabati et al. (pages 670–7) have evaluated four methods of displaying information using graphical, numerical or mixed formats. In a study with 20 anaesthetists they found that a mixed numerical– graphical display had the best reaction times and performance.

Happy Diwali

British Journal of Anesthesia: October 2009 issue

British Journal of Anesthesia: October 2009 issue
Volume 103 Number 4 October 2009

Thanks to a friend who wants to be anonymous, he has kindly shared this issue with all of us.
In this issue........

Training and assessment in anaesthesia
The recent implementation of the Working Time Directive (WTD) has raised awareness of the constraints placed on time for training. In the BJA this month there are a number of timely articles that help to define the problems and to provide solutions. Two articles compare the ‘before and after’ effect of the WTD on training. Underwood and McIndoe (pages 518–23) compared training data from 1997 and 2008 in a large teaching hospital and found that case numbers and supervision for trainees had been maintained over that period. In contrast, Fernandez and Williams (pages 566–9), comparing log-book data from 2000 and 2007 for trainees in a large paediatric hospital, found a decrease in the case-load of specialist trainees. The changes in training time means that improved methods of assessment of trainees are required. The methods of assessing procedural skills in trainees are covered in a thorough review of the subject by Bould et al. (pages 472–83). A method of workplace-based assessment (mini-Clinical Evaluation Exercise) (Weller et al., pages 524–30) was found to be of use in improving skills, allowing assessment and promoting trainee/supervisor interaction. The use of simulators for teaching and assessment is increasing and two articles address these different aspects. Grottke et al. (pages 594–600) describe an MRI-based virtual reality simulator for teaching of regional block techniques. Finally, the addition of a formal debriefing session to simulation scenarios was shown to improve performance (Morgan et al., pages 531–7).

Magnesium and anaesthesia
The potentially beneficial applications of magnesium as a drug are increasing. The perioperative effects of magnesium are assessed in two studies. In a comparison of remifentanil infusion or magnesium (bolus dose, 50 mg kg21 followed by infusion, 15 mg kg21 h21) for controlled hypotension for middle ear surgery, Ryu et al. (pages 490–5) found similar intraoperative conditions between the two groups but improved postoperative pain scores and less PONV in the magnesium group. In a RCT comparing magnesium (50 mg kg21) or placebo, Jee et al. (pages 484–9) found attenuation of arterial pressure increases during laparoscopic cholecystectomy, with reduction in catecholamine response. The pharmacology of magnesium and its emerging applications in anaesthesia and intensive care are addressed in an excellent editorial by James (pages 465–467).

Ultrasound-guided blocks
The use of ultrasound guidance for the placement of nerve blocks is increasing and has been described in previous issues of the BJA. Two new studies provide further useful data on these techniques. The topography of the brachial plexus in the axilla and upper arm is described using detailed ultrasonography (Christophe et al., pages 606–12). This shows that while the order of nerves around the axillary artery is constant, there are frequent variations in their arrangement. The use of ultrasound-guided TAP block for analgesia after open appendicectomy was found to decrease postoperative morphine requirements and pain scores (Niraj et al., pages 601–5). In an accompanying editorial (Bonnet et al., pages 468–70) the current role of TAP block is evaluated.

Paediatric Anaesthesia :Doyle

Paediatric Anaesthesia :Doyle (Oxford Specialist Handbooks in Anaesthesia)

This handbook covers all aspects of modern paediatric anaesthesia; from common ENT and general surgical day case procedures through to specialist neonatal, neurosurgical, spinal and cardiac procedures restricted to paediatric centres. Pediatric Anesthesia deals with individual surgical procedures on a case by case basis covering the whole care of a patient from preoperative assessment, through the provision of anaesthesia and pain relief, to postoperative care. There are also chapters on resuscitation, complications during anaesthesia, congenital syndromes and medical conditions which affect anaesthesia and sedation of children.
A concise source of knowledge and advice, this handbook provides rapid access to relevant material with sufficient detail and explanation to make it invaluable to a trainee new to the sub-specialty or any specialist practitioner working on pediatric anesthesia.