Brit J Hosp Med
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Head and neck cancer surgery presents significant challenges for the anaesthetist. A thorough multidisciplinary preoperative assessment and optimisation of the patient is essential, including nutritional and psychological evaluation. The incidence of a difficult airway is high, and the anaesthetist must be skilled in advanced airway techniques. ⋯ The Enhanced Recovery after Surgery Society and the Society for Head and Neck Anaesthesia consensus recommendations provide guidance on current best practice. Despite continued debate, it now appears that this constitutes goal-directed fluid therapy, coupled with judicious vasopressor therapy sufficient to achieve an adequate mean arterial pressure. Emerging techniques such as prehabilitation and postoperative near-infrared spectroscopy flap monitoring provide hope of improved outcomes going forward.
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Heart failure has many causes. Although new drugs, devices and technologies are available, the survival rate and prognosis of patients with heart failure remain poor, placing a significant burden on individuals and society. ⋯ With medical advances, however, previous heart failure risk scores are not fully applicable to current practice, particularly because of the classification as heart failure with reduced ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with preserved ejection fraction. This article describes the use of risk prediction scores for heart failure patients with different clinical status and discusses their clinical applicability.
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Hypertension is a leading risk factor for cardiovascular disease and all-cause mortality globally. Hypertension and chronic kidney disease are closely intertwined conditions as hypertension can lead to deteriorating renal function and progressive chronic kidney disease can contribute to worsening hypertension. In the setting of chronic kidney disease, the pathophysiology of hypertension is complex and involves the interplay of many factors including a reduced number of functioning nephrons, sodium retention and volume expansion, upregulation of the sympathetic nervous system, hormonal factors such as upregulation of the renin-angiotensin-aldosterone system, and endothelial dysfunction. ⋯ This review discusses the pathophysiological mechanisms that contribute to hypertension, including sympathetic nervous system activity, the renin-angiotensin-aldosterone system and the role of sodium. In the setting of chronic kidney disease, the relationship with hypertension and renovascular disease as a potential cause and target for therapeutic intervention is briefly reviewed. Finally, treatment options, targets and the long-term cardiovascular benefits of optimal blood pressure control are discussed.
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Osteoarthritis is a syndrome characterised by joint pain, resulting in functional limitation and a decreased quality of life. This chronic condition is one of the major public health problems facing society today and is likely to become more prevalent. The expected increase is because of the primary causative factors, advancing age and obesity, becoming increasingly prevalent in society. ⋯ This article examines the current management strategies, as outlined by the National Institute for Health and Care Excellence guidelines for osteoarthritis. Although numerous surgical options are available, this article focuses on the non-operative strategies currently used. The emphasis in this article is on general principles of treatment rather than treatment options for specific joints.
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The choice of anaesthesia technique for neurosurgical procedures has always been debatable. Despite the well-known effects of volatile anaesthetics on intracranial pressure, these are still widely used. This article explores the advantages and disadvantages of using volatile or total intravenous anaesthesia in patients undergoing neurosurgery.