What Is an Anaesthetist?
Anaesthetists are specialist doctors who are responsible for providing anaesthesia to patients for operations and procedures. In addition anaesthetists have a range of practice which extends beyond anaesthesia for surgery to include pain management and intensive care. Anaesthetists form the largest specialty group of doctors in NHS hospitals. They are doctors who have chosen after qualifying to undertake postgraduate specialist training of at least seven years in anaesthesia, intensive care medicine and pain management. Most consultant anaesthetists have developed subspecialist interests in a particular area of surgical practice, or in pain management or critical care. In the Trust there are... Read More
Anesthetists and anesthesiologists are two types of medical professionals who administer anesthesia to patients during medical procedures. They often work together to provide pain relief before, during and after a patient’s surgical, obstetrical or therapeutic procedure. Both positions require an interest in the medical profession and a dedication to the years of training required. To enter either profession, you should be compassionate, patient and willing to work long hours. The jobs are demanding, but you can help provide needed relief to those experiencing pain, making them very worthwhile professions. The primary differences between an anesthesiologist versus an anesthetist are the... 
Physician anesthesiologists are usually in charge of providing the following types of anesthesia care: General anesthesia: This type of anesthesia is provided through an anesthesia mask or IV and makes you lose consciousness. It is used for major operations, such as a knee replacement or open-heart surgery. Monitored anesthesia or IV sedation: IV sedation causes you to feel relaxed and can result in various levels of consciousness. Depending on the procedure, the level of sedation may range from minimal (making you drowsy but able to talk) to deep (meaning you won’t remember the procedure). This type of anesthesia often is... 
If you’re preparing for surgery, you’ve probably given a lot of thought to the education, training and experience of the surgeon performing the procedure. But you may not have thought much about the physician anesthesiologist or the importance of his or her medical expertise in your procedure — before, during and after — to keep you safe and comfortable. Physician anesthesiologists meet with you and your surgeon before surgery to assess your health and make decisions to ensure your anesthesia care is as safe and effective as possible. They monitor your vital signs during surgery, including how well your heart... 
Uterine rupture is a potentially catastrophic complication of caesarean section. Atypical rupture occurring away from the previous scar site is extremely rare with less than 20 cases reported in the literature. A 38-yearold presented at 37 weeks gestation with maternal collapse. Emergency caesarean section revealed foetal loss and a posterior uterine rupture with an intact lower uterine segment. A subtotal hysterectomy was performed. Disseminated intravascular coagulopathy (DIC) developed rapidly and required massive transfusion. The patient was discharged home twelve days later. Posterior uterine rupture is rare and requires prompt surgical intervention and multi-disciplinary teamwork to prevent serious maternal morbidity. Uterine... 
Congenitally corrected transposition of the great arteries is once in a blue moon heart defect in which the heart’s lower two chambers and ventricles, are reversed in their positions. Right ventricle (RV) battles to function as the ventricular pump against the substantial systemic vascular resistance. As the age increases, these parturient tend to develop primitive ventricular dysfunction. CCTGA has a prevalence of 0.4–0.6% of all congenital heart disease cases and complete heart block develops in cases of 30% CCTGA. In these parturients the physiological cardiovascular changes of pregnancy may expedite the rate of ventricular failure. We describe anesthetic challenges in... 
Ultrasound-guided axillary block is a standard anesthetic technical for surgery of the lower part of the upper limbs including the arm, elbow, forearm, wrist and fingers. We carried out a prospective and descriptive study over 03 years on patients undergoing upper limb surgery under ultra sound guided axillary block, out in the surgery department of the CHDII saint croix Isoanala south Madagascar, rural area. The purpose of this study is to evaluate the efficiency of ultrasound-guided axillary blocks for upper limb surgery. We included 67 patients with a mean age of 35.53±10.68 years with a predominantly male population. The majority... 
Pudendal neuralgia is a neuropathic pain syndrome consisting of debilitating pain along the pudendal nerve distribution. Current evidence offers a variety of therapeutic options, however many patients demonstrate inadequate pain control. We present a 56 year old woman with an eight year history of left groin, vaginal, and rectal pain consistent with pudendal neuralgia. After failing physical therapy, pharmacologic therapy, and surgical intervention, a spinal cord stimulator was placed at the conus medullaris with subsequent 65% pain relief and improved sitting time. This report demonstrates spinal cord stimulation uniquely targeted to the conus medullari as an effective treatment modality for... 
For many years since renal biopsies entered the armamentarium of the nephrologist, the standard approach to assessment was light microscopy with gradual addition of selected special stains, immunofluorescence, and then electron microscopy. An explosion in understanding of the spectrum of etiologies underlying the limited repertoire of lesions in the kidney, coupled with in-depth mining of morphologic lesions and their implications for prognosis, has ensued over the last decades. An exciting direction for exploration of new information for pathogenesis of glomerular diseases was driven by the seminal observation that mutations in nephrin were causal in congenital nephrotic syndrome of Finnish type.... 
The Editorial Team of Kidney International would like to reassure our readership that we will continue to bring you high-quality information throughout the COVID-19 pandemic to help all of us deal with the crisis and provide high-quality care to our patients. We have a mechanism in place to rapidly review and arrive at publication decisions for papers on the COVID-19–related implications for the kidney and release these papers in an open access format within one week after acceptance. We believe the best way nephrologists can contribute to the fight against this disease is by arming ourselves with the best and... 
Amniotic fluid embolism (AFE) is a rare but serious obstetric condition. Its presentation includes a variety of signs and symptoms, most commonly hypoxia, hypotension, cardiac arrest, disseminated intravascular coagulopathy (DIC) and severe bleeding. A 28-year-old G1P0 full-term patient was admitted for an acute severe itching episode. After ruling out cholestasis, induction of labor and epidural analgesia was started. No significant progress of labor was seen in the next several hours. Blood was seen soaking the epidural catheter site. This was thought of as possibly an early sign of DIC. The decision was made to perform an urgent cesarean section. The... 
Methylene blue is a widely used dye for sentinel lymph node mapping for solid tumours especially breast cancer. Anaphylaxis is a life threatening reaction that can occur during Anaesthesia. Methylene blue has been reported to be the safest dye, indeed a recent systematic review and metaanalysis reported no cases of anaphylactic reactions. We report a case of a 37-yr-old female who experienced an anaphylactic reaction to methylene blue resulting in Intensive Care Admission. Methylene blue is a dye used for sentinel lymph node mapping for numerous solid tumor’s particularly breast cancer. Several blue dyes are available however methylene blue is... 
It’s been a well-known fact that anaesthetist and surgeon work as a team for the betterment for the patient. There are various situations where anaesthetists have provided the lifesaving suggestions to the surgeon in a crux situation. Airway manipulative procedures are a difficult situation for the anaesthetists and surgeon both as the working field is same; so the time is the limiting factor in these cases because more is the time taken more are the chances for hypoxic episodes. Distally located lower respiratory tract foreign body removal especially in pediatric cases are tricky situations and are the most challenging and... 
Meningitis post-administration of a central neuraxial blockade is although a rare complication but a potentially fatal one. Breach in aseptic precautions leading to introduction of bacteria is considered the most probable cause and haematogenous spread due to microscopic vessel injury in symptomatic or asymptomatic bacteremia is also one of the etiologies. Mostly, a single anaesthesiologist may be seen with such cluster of cases. Sometimes defective drugs or faulty equipment used for the procedure may also lead to this complication. We report two cases where spinal anesthesia was performed by different anaesthesiologist’s in different operation theatres of the same hospital, which... 
Extensive maxillo-facial surgery can create significantly complex airway anatomy. We present the case report of a 31-yrs-old female presenting for elective day case surgery. She had a past medical history of Asperger Syndrome and T4 N0 spindle cell sarcoma of the left maxilla for which she had a left orbital exenteration and maxillectomy and left-sided neck dissection in 2004 with no anaesthetic complications. This was accompanied with post-operative radiotherapy which had left her with severe radiation trismus. Her American Society of Anaesthesiologists (ASA) grade was II and airway assessment found that she had moderate neck flexion and extension with a... 
Leiomyosarcoma is an aggressive soft tissue sarcoma derived from smooth muscle cells typically of uterine, gastrointestinal or soft tissue origin. Leiomyosarcoma of soft tissue is thought to arise from the smooth muscle cells lining small blood vessels. It can also arise directly from the viscera, including the gastrointestinal tract and uterus. We present a case of large retroperitoneal leiomyosarcoma with close proximity to major blood vessels and left renal vessels involvement, for tumour excision and its anaesthetic management. A relatively long surgery with major blood loss along with the left nephrectomy made this procedure challenging for the anaesthesiologist in maintaining... 
COMMENTARY An 83-year-old white male with past medical history of cerebrovascular accident, urinary incontinence with indwelling Foley catheter, atrial fibrillation, hyperlipidemia, systolic cardiomyopathy was brought by family for purple discoloration of Foley tubing and urinary bag for last 2 days (Figure 1). Patient complained of malaise and mild constipation. He had no history of trauma to the catheter. He denied fever, chills or dysuria. Physical examination was unremarkable with no suprapubic tenderness DISCUSSION Change of Foley catheter and treatment of underlying urinary tract infection form the mainstay of treatment of Purple Urine Bag Syndrome (PUBS). It is an interesting but... 
Abstract Immune mediated injuries comprise a major bulk of renal disorders that mostly manifest as acute or chronic glomerulonephritides. Besides initial investigations for renal disorders, diagnosis of immune mediated renal diseases requires a battery of immunological tests and renal histopathology. The laboratory tests include anti-nuclear antibodies (ANA) followed by anti-double stranded deoxyribonucleic acid antibodies (antidsDNA) and/or anti-extractable nuclear antigens (anti-ENA), complement levels (C3, C4, factor H), rheumatoid factor (RF), C reactive proteins (CRP), anti-streptococcal antibodies including anti streptolysin-O titer (ASOT) and anti-deoxyribonuclease B (anti-DNAse B), anti-neutrophilcytoplasmic antibodies (ANCA), anti-glomerular-basement membrane antibodies (anti-GBM), cryoglobulins detection, anti-phospholipid antibodies, nephritic factor, anti-phospholipase A2... 
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly first described in 1908 and has an incidence of 0.26% of all cases of congenital heart diseases. Nearly 90% of patients die within one year if left untreated; however, a few patients can survive into adulthood. This depends on the inflow of blood to the left coronary artery (LCA) via collaterals from the right coronary artery (RCA). We report a case of a 45-year-old woman referred to the preoperative anesthesia clinic in April 2017 for a laparoscopic hysterectomy under general anesthesia. Anomalous origin... 
We report a case of a 35 year old woman with colon cancer metastatic to liver and lung who presented for exploratory laparotomy and/placement of hepatic arterial infusion pump for chemotherapy. Surgical course was notable for aberrant hepatic artery anatomy requiring extended dissection time, vascular surgery consultation, and use of substantial methylene blue to aid in visualization. Of note, patient’s history was also significant for anxiety and depression, for which she was being treated with the selective serotonin reuptake inhibitor (SSRI) duloxetine (Cymbalta). The patient subsequently developed serotonin syndrome in the postoperative period but fully recovered. Our case highlights the... 
ABSTRACT Aim In peritoneal dialysis (PD), fluid overload is frequent and associated with cardiac dysfunction and mortality. As it is considered a modifiable risk factor, we wished to describe clinical determinants of fluid overload in a longitudinal cohort of PD outpatients. Methods We consecutively included PD outpatients treated with CAPD or APD attending for their routine clinical visit at a single tertiary hospital. Extracellular water (ECW) to total body water (TBW) ratio was measured by multifrequency bioelectrical impedance (MFBIA). Peritoneal transport characteristics were measured with a standard peritoneal equilibration test. Patients had a second follow‐up visit with the same measurements.... 
Introduction Rituximab is currently used after the conventional agents have failed in the management of steroid dependent (SD)/ steroid resistant (SR) podocytopathies and have a safer toxicity profile. We report 53 adults with podocytopathies who were managed effectively with CD19‐targeted rituximab therapy. Methods This was a prospective study carried out at a tertiary care centre in India between January 2014 to June 2019. Adults between 16‐60舁years with SD, frequently relapsing (FR), and SR nephrotic syndrome (NS) due to podocytopathy received rituximab in a CD19‐targeted approach. Primary outcome: Percentage of patients who were in remission at 6 and 12 months. Secondary... 
Abdominal pregnancy is a rare form of ectopic pregnancy associated with high mortality and morbidity for both the fetus and the mother. It is often observed in developing nations with poor outcomes as most cases result in fetal demise. We present a 48 year old parturient diagnosed with abdominal pregnancy who elected to continue the pregnancy despite the communicated risks. The patient was admitted to the hospital at 24 weeks of gestational age for antepartum observation with the goal of surgical delivery at 28 weeks of gestation. General anesthesia was provided with multiple large bore intravenous access in anticipation of... 
Complex regional pain syndrome is a rare condition that causesdebilitating pain and loss of mobility to one or more extremities. While multiple tools have been developed to diagnose this disease, the treatments currently employed are highly variable and the results are unpredictable. In order to address this, we did a review of the literature and created a standardized six week complex regional pain syndrome treatment protocol which included many treatments with proven benefit employed simultaneously. In this article, we present our brief literature review, our standardized protocol, and three case reports of patients who had successful treatment of their disease... 
Severe aortic valvular disease can be treated with valve replacement using an autologous pulmonary valve, also known as the Ross procedure. In young females who wish to bear children in the future, the Ross procedure may be a preferable option over mechanical or bioprosthetic valve replacement, as it offers long-term durability without the need for life-long anticoagulation. However, it is not without complications. Here in, we present the successful perioperative anesthesia management of a patient with history of Ross procedure and mitral valve bioprosthesis, with subsequent development of severe aortic insufficiency and moderate mitral stenosis, who delivered a preterm infant... 
Regional anesthesia is the use of local anesthetics to block sensations of pain from a large area of the body, such as an arm or leg or the abdomen. Regional anesthesia allows a procedure to be done on a region of the body without your being unconscious. Major types of regional anesthesia include: Peripheral nerve blocks: A local anesthetic is injected near a specific nerve or bundle of nerves to block sensations of pain from the area of the body supplied by the nerve. Nerve blocks are most commonly used for surgery on the arms and hands, the legs and... 
The anaesthetic management of a parturient with isolated pulmonic stenosis and severe pre-eclampsia is particularly challenging. Each of this needs to be evaluated as a separate entity and managed in unison. The challenges that we faced were compounded by the urgent nature of Caesarean section in view of equivocal NST with meconium stained liquor. This provided us with little opportunity to evaluate the present cardiac status and the spectrum of manifestations of pre-eclampsia. Central venous and arterial access was promptly established to enable monitoring of fluid and hemodynamic status peri-operatively. Management of preeclampsia was initiated by the use of intra-venous... 
High output ileostomy is not uncommon and when diagnosed, it should be managed expeditiously and systematically in order to prevent complications such as dehydration, electrolyte disturbance and acute kidney injury. A multi modal regimen consisting of correction of fluid and electrolyte deficit; restriction of oral hypotonic fluids with dietary modifications and use of anti-motility drugs was sequentially and concomitantly introduced to achieve a favourable clinical outcome. Patient education regarding dietary modifications and recognition of dehydration due to high output stoma is paramount. A co-ordinated multi-disciplinary approach involving the patient, family, dietician, community nurses and hospital doctor is vital. High output... 
A renal diet is a diet that restricts foods which are high in sodium, potassium and phosphorus. The diet is recommended for people with late stages of chronic kidney disease and end-stage kidney disease. The diet attempts to reduce the build-up of micronutrients in the blood in order to prevent, arrhythmias, bone disorders, fluid overload, vascular calcification and hypertension. The renal diet is restrictive. Foods such as potatoes, orange juice, tomatoes, bananas, dairy products and processed meats should be avoided. Furthermore foods such as orange/ orange juice and avocados also contains a good dose of potassium therefore it’s recommended to... 
Heart disease can cause kidney disease, but kidney disease can also cause heart disease. Heart disease is the most common cause of death among people on dialysis. When your kidneys are not working well, they cannot support the other parts of your body as they should. This can cause problems with your heart. Heart disease often does not have any symptoms until your heart and blood vessels are badly damaged. The best way to prevent heart disease is to prevent the problems that can lead to it, such as anemia, high blood pressure and problems with calcium and phosphate levels.... 
End-of-life care (or EoLC) refers to health care for a person with a terminal condition that has become advanced, progressive, and/or incurable. End-of-life care requires a range of decisions, including questions of palliative care, patients' right to self-determination (of treatment, life), medical experimentation, the ethics and efficacy of extraordinary or hazardous medical interventions, and the ethics and efficacy even of continued routine medical interventions. In addition, end-of-life often touches upon rationing and the allocation of resources in hospitals and national medical systems. Such decisions are informed both by technical, medical considerations, economic factors as well as bioethics. In addition, end-of-life... 
Dental anesthesia (or dental anaesthesia) is a field of anesthesia that includes local anesthetics, sedation, and general anesthesia. In dentistry, the most commonly used local anesthetic is lidocaine (also called xylocaine or lignocaine), a modern replacement for procaine (also known as novocaine). Its half-life in the body is about 1.5–2 hours. Other local anesthetic agents in current use include articaine (also called septocaine or ubistesin), bupivacaine (a long-acting anesthetic), Prilocaine (also called Citanest), and mepivacaine (also called Carbocaine or Polocaine). Different types of local anaesthetic drugs vary in their potency and duration of action. A combination of these may be... 
An 83-year-old white male with past medical history of cerebrovascular accident, urinary incontinence with indwelling Foley catheter, atrial fibrillation, hyperlipidemia, systolic cardiomyopathy was brought by family for purple discoloration of Foley tubing and urinary bag for last 2 days (Figure 1). Patient complained of malaise and mild constipation. He had no history of trauma to the catheter. He denied fever, chills or dysuria. Physical examination was unremarkable with no suprapubic tenderness. Change of Foley catheter and treatment of underlying urinary tract infection form the mainstay of treatment of Purple Urine Bag Syndrome (PUBS). It is an interesting but unusual presentation... 
Immune mediated injuries comprise a major bulk of renal disorders that mostly manifest as acute or chronic glomerulonephritides. Besides initial investigations for renal disorders, diagnosis of immune mediated renal diseases requires a battery of immunological tests and renal histopathology. The laboratory tests include anti-nuclear antibodies (ANA) followed by anti-double stranded deoxyribonucleic acid antibodies (antidsDNA) and/or anti-extractable nuclear antigens (anti-ENA), complement levels (C3, C4, factor H), rheumatoid factor (RF), C reactive proteins (CRP), anti-streptococcal antibodies including anti streptolysin-O titer (ASOT) and anti-deoxyribonuclease B (anti-DNAse B), anti-neutrophilcytoplasmic antibodies (ANCA), anti-glomerular-basement membrane antibodies (anti-GBM), cryoglobulins detection, anti-phospholipid antibodies, nephritic factor, anti-phospholipase A2... 
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain's widely used definition defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". In medical diagnosis, pain is regarded as a symptom of an underlying condition. Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves once the noxious stimulus is removed and the body has healed, but... 
Caesarean section, also known as C-section, or caesarean delivery, is the use of surgery to deliver babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk. Reasons for this may include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, or problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed... 
Metabolic syndrome and chronic kidney disease (CKD) have become global public health problems due to their increasing prevalence and their close associations with cardiovascular events. First recognised by Reavenin 1988, metabolic syndrome (previously known as syndrome X) is a complex pathophysiological issue and essentially considered as an assembly of cardiovascular and metabolic risk factors, which include abdominal obesity, dyslipidaemia, hypertension and insulin resistance/ hyperglycaemia components. Over the years, there have been several definitions of metabolic syndrome. In most of the epidemiological studies NCEP-ATP (National Cholesterol Education Program-Adult Treatment Panel III) criteria were used. Lastly, Harmonized (Consensus) Definition incorporating IDF (International... 
Ocular surgery may be performed under topical, local or general anesthesia. Local anaesthesia is more preferred because it is economical, easy to perform and the risk involved is less. Local anaesthesia has a rapid onset of action and provides a dilated pupil with low intraocular pressure. History: Susruta Samhita has evidences of use of anaesthesia for ocular surgeries. Inhalational anaesthesia was used for this purpose. Egyptian surgeons used carotid compression to produce transient ischemia during eye surgery to reduce the perception of pain. In 1884, Karl Koller used cocaine for ocular surgery. The same year, Herman Knapp used cocaine for... 
On behalf of our esteemed journal 
Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles (see diagram). In other words, the filtration rate is dependent on the difference between the higher blood pressure created by vasoconstriction of the input or afferent arteriole versus the lower blood pressure created by lesser vasoconstriction of the output or efferent arteriole. GFR is equal to the Clearance Rate when any solute is freely filtered and is neither reabsorbed... 
Renal function is an indication of the kidney's condition and its role in renal physiology. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr or CrCl) is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the GFR. Creatinine clearance exceeds GFR due to creatinine secretion, which can be blocked by cimetidine. Both GFR and CCr may be accurately calculated by comparative measurements of substances in the blood and urine, or estimated by formulas using just a blood test result... 
Pain management in children is the assessment and treatment of pain in infants and children. Pain management, pain medicine, pain control or algiatry, is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain. The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurses. The team may also include other mental health specialists and massage therapists. Types Acute: Usually, acute pain has an obvious cause and is expected to last for a few days or weeks. It is usually managed with... 
Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. The attending trauma surgeon also leads the trauma team, which typically includes nurses and support staff as well as resident physicians in teaching hospitals. Training: Most United States trauma surgeons practice in larger centres and complete a 1-2 year trauma surgery fellowship,... 
In medicine, dialysis (from Greek διάλυσις, Dialysis, "dissolution"; from διά, dia, "through", and λύσις, lysis, "loosening or splitting") is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy. Dialysis is used in patients with rapidly developing loss of kidney function, called acute kidney injury (previously called acute renal failure), or slowly worsening kidney function, called Stage 5 chronic kidney disease, (previously called chronic kidney failure, end-stage renal disease, and end-stage kidney disease). Dialysis is used as a temporary... 
Renal cell carcinoma (RCC) is a kidney cancer that originates in the lining of the proximal convoluted tubule, a part of the very small tubes in the kidney that transport primary urine. RCC is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Initial treatment is most commonly either partial or complete removal of the affected kidney(s).Where the cancer has not metastasised (spread to other organs) or burrowed deeper into the tissues of the kidney, the five-year survival rate is 65–90%,but this is lowered considerably when the cancer has spread. The body is remarkably... 
Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere.This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents. Airway management is commonly divided into two categories: Basic and Advanced. Basic techniques are generally non-invasive and do... 
Cardiothoracic anesthesiology is a sub speciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and Pediatric patients undergoing cardiothoracic surgery and related invasive procedures. It deals with the anesthesia aspects of care related to surgical cases such as open heart surgery, lung surgery, and other operations of the human chest. These aspects include perioperative care with expert manipulation of patient cardiopulmonary physiology through precise and advanced application of pharmacology, resuscitative techniques, critical care medicine, and invasive procedures. This also includes management of the cardiopulmonary bypass (heart-lung) machine, which most cardiac procedures require... 
Good pasture syndrome (GPS), also known as anti-glomerular basement membrane disease, is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Good pasture’s antigen. Good pasture syndrome may quickly result in permanent lung and kidney damage, often leading to death. It is treated with medications that suppress the immune system such as corticosteroids and cyclophosphamide, and with plasmapheresis, in which the antibodies are removed from the... 
Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure. It is typically due to a bacterial infection, most commonly Escherichia coli. Risk factors include sexual intercourse, prior urinary tract infections, diabetes, structural problems of the urinary tract, and spermicide use. The mechanism of infection is usually spread up the urinary tract. Less often infection occurs through the bloodstream. Diagnosis is typically based on symptoms and supported by... 
An anesthesiologist is a doctor who gives a patient medication so they do not feel pain when they are undergoing surgery. However, these specialist physicians play a much wider role than just putting people to sleep for surgery. They are also involved in a range of other medical procedures, including carrying out assessments in critical care units, dealing with emergency situations, and giving advice about pain management. The anesthesiologist provides pain relief before, during and after surgery, but they also fulfill a number of other important roles. Pain relief in surgery Before an operation, a patient will meet... 
Palliative care (derived from the Latin root palliare, or “to cloak”) refers to an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness. Within the published literature, many definitions of palliative care exist; most notably, the World Health Organization describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.” Palliative... 
Hematuria (American English) or haematuria (British English) is a clinical sign. It is defined by the presence of blood or red blood cells in the urine. An anatomical framework is helpful in developing a comprehensive differential diagnosis. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. These include the urinary system, female reproductive system, and integumentary system. Urinary causes occur anywhere between the kidney glomerulus and the urethral meatus. These can be divided into glomerular and non-glomerular causes. Non-glomerular causes can be further subdivided into upper urinary tract and lower urinary tract causes. After... 
Nephrologists are physicians who specialize in the diagnosis and treatment of kidney disease. What conditions are treated by a kidney doctor, and when is a referral to one of these specialists needed? If you haven't heard about nephrology (the study of kidney disease) before, it's not surprising. Chronic kidney disease (CKD) is often referred to as the "silent killer," as many people have mild symptoms or no symptoms at all when they are diagnosed. There are many different terms which can be used to describe kidney disease which can add to the confusion. As noted above, Nephrologists are doctors who... 
Geriatric anesthesia (or geriatric anaesthesia) is the branch of medicine that studies anesthesia approach in elderly. The perioperative care of elderly patients differs from that of younger patients for a number of reasons. Some of these can be attributed to the changes that occur in the process of aging, but many are also caused by diseases that accompany seniority. The distinction between so-called normal aging and pathological changes is critical to the care of elderly people. Anesthesia and surgery has become more common as the population survives longer. Perioperative management of the geriatric patients requires knowledge’s about changes associated with... 
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions. Anesthetists sometimes combine both general and local anesthesia... 
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; or chronic kidney failure, which develops slowly. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, high blood potassium, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anemia. Causes of acute kidney failure include low blood pressure, blockage of the urinary tract,... 
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage kidney disease. Kidney transplantation is typically classified as deceased-donor (formerly known as cadaveric) or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. Exchanges and chains are a novel approach to expand the living donor pool. In February 2012, this novel approach to expand the living donor pool resulted in the largest chain in the world,... 
Pain management, pain medicine, pain control or algiatry, is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain. The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurses. The team may also include other mental health specialists and massage therapists. Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of chronic (long-term) pain, however, frequently requires the coordinated efforts... 
Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include analgesia (relief from or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), or unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized. Anesthesia enables the painless performance of medical procedure that would otherwise cause severe or intolerable pain to an unanesthetized patient, or would otherwise be technically unfeasible. Three broad categories of anesthesia exist: General anesthesia suppresses central nervous system activity and results in... 
Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Glomerulonephritis can come on suddenly (acute) or gradually (chronic). Glomerulonephritis occurs on its own or as part of another disease, such as lupus or diabetes. Severe or prolonged inflammation associated with glomerulonephritis can damage your kidneys. Treatment depends on the type of glomerulonephritis you have. Symptoms Signs and symptoms of glomerulonephritis depend on whether you have the acute or chronic form and the cause. Your first indication that something is wrong might... 
A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.Doctors typically treat urinary tract infections with antibiotics. But you can take steps to reduce your chances of getting a UTI in the first place. Symptoms: Urinary tract infections don't always cause... 
The perioperative management of patients using cannabis, either for recreational or medical purposes, remains a challenge for the anesthesiologist due to its multi-organ side effects. However, the interactions between cannabinoids and general anesthetic agents, as well as the impact on intraoperative patient care are not yet fully understood. Discussing cannabis pharmacology and perioperative considerations for naïve and chronic users. The Endocannabinoid System: The Endocannabinoid System (ECS) is a biological system consisting of specific ligands, G protein-coupled cannabinoid receptors (CB-R), neurotransmitters and enzymes mediating the endocannabinoids synthesis and metabolism . N-arachidonoyl-ethanolamine (AEA; anandamide) and 2-arachidonoylglycerol (2-AG) are endocannabinoids (ECBs) synthetized from phospholipids of the... 
Lung-protective ventilation during cardiac surgery: Lung-protective ventilation strategies use low tidal volume (TV), low driving pressure, and positive end-expiratory pressure (PEEP). In a retrospective study of nearly 4700 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), lung-protective ventilation was associated with fewer postoperative pulmonary complications (pneumonia, prolonged postoperative mechanical ventilation, need for reintubation, and/or poor oxygenation with arterial oxygen tension [PaO2]/fraction of inspired oxygen [FiO2] ratio <100 mmHg) compared with other ventilation strategies. A sensitivity analysis revealed that use of driving pressure <16 mmHg alone, but not PEEP or low TV, was also independently associated with fewer pulmonary complications. Although... 
Kidney stone disease, also known as urolithiasis, is when a solid piece of material (kidney stone) develops in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms. If a stone grows to more than 5 millimeters (0.2 in), it can cause blockage of the ureter, resulting in severe pain in the lower back or abdomen. A stone may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a kidney stone will have another within... 
A 17-year-old woman who had been healthy since birth developed postobstruction pulmonary edema (POPE) after maxillofacial surgery. She was extubated in a semi-conscious state after general anesthesia, and developed severe airway obstruction due to glossoptosis, and blood and secretions in the oral cavity. When the obstruction was released approximately 10 min later, the chest radiograph showed an increased cardiothoracic ratio, and cardiac ultrasonography showed a reduction in the left ventricular ejection fraction when compared to the normal values for the same age. A diagnosis of type-I POPE with associated left ventricular dysfunction was made, and oxygen and diuretic administration were... 
The 
Nephritic syndrome is a collection of symptoms due to kidney damage. This includes protein in the urine, low blood albumin levels, high blood lipids, and significant swelling. Other symptoms may include weight gain, feeling tired, and foamy urine. Complications may include blood clots, infections, and high blood pressure. Causes include a number of kidney diseases such as focal segmental glomerulosclerosis, membranous nephropathy, and minimal change disease. It may also occur as a complication of diabetes or lupus. The underlying mechanism typically involves damage to the glomeruli of the kidney. Diagnosis is typically based on urine testing and sometimes a kidney... 
Polycystic kidney disease (PKD or PCKD, also known as polycystic kidney syndrome) is a genetic disorder in which the renal tubules become structurally abnormal, resulting in the development and growth of multiple cysts within the kidney. These cysts may begin to develop in utero, in infancy, in childhood, or in adulthood. Cysts are non-functioning tubules filled with fluid pumped into them, which range in size from microscopic to enormous, crushing adjacent normal tubules and eventually rendering them non-functional as well. PKD is caused by abnormal genes which produce a specific abnormal protein; this protein has an adverse effect on tubule... 
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions. Anesthetists sometimes combine both general and local anesthesia... 
The core element of the specialty is the study and use of Anesthesia and Anesthetics to safely support a patient's vital functions through the perioperative period. Since the 19th century, anesthesiology has developed from an experimental area with non-specialist practitioners using novel, untested drugs and techniques into what is now a highly refined, safe and effective field of medicine. In some countries anesthesiologists comprise the largest single cohort of doctors in hospitals. Trends for the future of anesthesiology: Lower income(as adjusted for inflation): There will be multiple causes for this: a) An aging population, with the significantly... 
Urology is a branch of medicine that specializes in the medical and surgical aspects of the female and male urinary tract as well as the male reproductive system. Urologists usually focus on any of these 7 subspecialties: Calculi for stones in the urinary tract Female urology for pelvic outlet relaxation disorders and urinary incontinence Male infertility Neuro urology for erectile dysfunction and voiding disorders Pediatric urology Renal transplantation Urologic oncology, which deals with cancer Common Concerns That Need the Attention of a Urologist: 1)Recurrent Urinary Tract Infection: UTI or urinary tract infection, as its name suggests, is the... 
Researchers reveal that cranberry juice is much better at preventing biofilm formation, the precursor of a urinary tract infection, than cranberry extracts. Having scientific research now proving the age old wisdom that cranberries are able to prevent a urinary tract infection, experts questioned if there’s a component of the berry that, when extracted plus condensed, probably in pill form, could be as beneficial as drinking cranberry juice or eating the sauce in preventing a urinary tract infection. Researchers examined proanthocyanidins or PACs, a group of flavonoids present in cranberries. Since they were considered to be the ingredient which provides the... 
Incorporation of acute pain modalities within anesthesia practices has greatly expanded over the years, and this has brought positive changes in patient care and physician payment. However, where new techniques become "standard of care," adjustments. As the preeminent provider of outsourced anesthesia billing and management services in America, we are always interested in how anesthesia providers are modifying their practices to take advantage of new pain management modalities and changing patient expectations. Anesthesia is not just focused on the operating room and the delivery suite. It is increasingly concerned with the entire perioperative episode. That includes the diagnosis and treatment... 
Our Journal 
Our Journal 
Our Journal 
Our Journal 
Our Journal 
Our Journal 
Our Journal 
Nephrology also studies systemic conditions that affect the kidneys, as diabetes and autoimmune disease; and systemic diseases that occur as a result of kidney disease, such as renal osteodystrophy and hypertension. A physician who has undertaken additional training and become certified in nephrology is called a nephrologist. The term "nephrology" was first used in about 1960. Before then, the specialty was usually referred to as "kidney medicine’’ Nephrology concerns the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Our Journal 
Nephrology is a specialty of medicine and Pediatric medicine that concerns itself with the kidneys: the study of normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy (dialysis and kidney transplantation). Our Journal 
The core element of the specialty is the study and use of anesthesia and Anesthetics to safely support a patient's vital functions through the perioperative period. Since the 19th century, anesthesiology has developed from an experimental area with non-specialist practitioners using novel, untested drugs and techniques into what is now a highly refined, safe and effective field of medicine. 
Anesthesiology, anaesthesiology, anaesthesia or anaesthetics is the medical speciality concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialised in this field of medicine is called anaesthesiologist. 
On behalf of the 
Our Journal 
On behalf of our esteemed journal 
... 
International Journal of Clinical Rheumatology is committed to distribute most elevated quality studies identified with clinical determination and administration of rheumatic ailments through facilitated parts of clinical consideration and clinical examination concentrated on propelling treatment and personal satisfaction for individuals with joint pain, immune system infections, bone issue, and related conditions. We feel contended to announce that our journal is successfully running in its Volume 14. We have successfully released special issues in our journal entitled Regenerative Medicine in Osteoarthritis and Epidemiology of Osteoporosis. Below are some most viewed articles in our journal. A novel treatment of knee degenerative... 
The editorial team of 
To commemorate its 10th Anniversary, 
The “
Journal of Blood Disorders and Treatment is peer-reviewed, open access, scholarly journal. It mainly aims at publishing the latest advancements in the field, enriching our understanding of blood disorders such as: 
International Journal of