Ultrasound for anaesthetists

With the increasing use of ultrasound in operating theatres, critical care units and accident and emergency departments it is important that operators are aware of the fundamentals, which underpin these imaging systems. Failure to do so can result in inadequate examination and potential clinical errors. The basic physics and technology of ultrasound are outlined. The principles of Doppler ultrasound are described and the methods in which Doppler data are displayed are considered. The parameters that can be modified by the operator and the effects these have on the resultant image are discussed. Advice is given on how to set up an ultrasound system and optimize the image. Examples are given of the use of ultrasound in the clinical environment with emphasis on the type of application most likely to be encountered by the anaesthetist.     

Continuous professional development for anaesthetists

Anaesthesia, as well as the whole of medicine, is involved in a revolution not only technical but also economic, because of the need for cost-containment in healthcare delivery. Continuing medical education, primarily devoted to updating knowledge and skills, is moving rapidly towards continuous professional development. A permanent evolution of practitioners is mandatory in order that they are able to adapt their practice to technical, ethical and economic changes, integrated in a team-working and multidisciplinary approach to patient care.     

Addicted anaesthetists

Drug dependence of anaesthetists occurs more often than in other physicians, especially the noxious usage of common substances in anaesthesiology and pain management like opioids and anaesthetics. Opioids are the most frequent abusively taken medication followed by benzodiazepines, illegal drugs, Propofol and Ketamine. Determining for the behavioral pattern is the easy access to the drugs. Especially as some of the addictive-drugs (e. g. Propofol, Ketamine) are not underlying any release-control. Recent German surveys confirm the American figures. For the development of drug dependence many factors like biographic, social and genetic aspects as well as the substances and their potential itself are significant. Furthermore, the presence of many stimuli encourages the relapse-risk for addicted people despite earlier abstinence. At least 16% of all cases and 37% of the Propofol-addiction cases proceed deadly. American studies with structured therapy-, rehabilitation- and follow-up surveillance-programs show a positive prognosis for anaesthetists. In Germany it requires rethinking and the establishment of comparable therapy-offers and facilities.     

Memory: a guide for anaesthetists

Episodic memory is the most 'human' of all memory systems, is integrally related to the hippocampus, and not only permits memories of the past in rich detail, but also allows projection of thoughts into the future. However, episodic memory is very sensitive to anaesthetic drugs and cannot be formed during adequate general anaesthesia. Ablation of episodic memory during consciousness is due to forgetting of memories, rather than inhibition of memory formation. There is a fine balance between being conscious with recollection and conscious with no recollection. A more detailed understanding of episodic memory in relation to other memory systems, as well as the relationship of the hippocampus to episodic memory function is provided. A synthesis of diverse knowledge is undertaken to identify potential mechanisms of amnesic drug effect, which will, of course, require further research to delineate.