When using ultrasound for regional anaesthesia it is essential to have a good understanding of basic ultrasound physics in order to obtain the best possible image. Part 2 of The Physics of Ultrasound will examine ultrasound phenomena, such as anisotropy and artefact, to understand how these can affect image quality and what practical steps can be taken to reduce their effects. The article will also look at the Doppler effect before finishing with a few practical hints and tips on how to ensure the best images are obtained.The Physics of Ultrasound – part 2 (218) - March 21, 2011

This tutorial will look at the background to CPET, its physiology, practicalities of performing the test and evidence supporting its use in pre-operative risk stratification. It will not cover direct interpretation of raw CPET data.Cardiopulmonary Exercise Testing (217) - March 14, 2011

Discusses the anatomy, physiology and pathology of the adrenal glands. The Adrenal Glands (216) - March 7, 2011

This Cerebral Challenge is reprinted from Update in Anaesthesia 26 and presents three clinical cases based around ECGs and radiological investigations. Each case is presented in turn followed by discussion at the end.Intensive Care Cerebral Challenge (215) - February 28, 2011

Pregnancy in women with mechanical heart valves is associated with an increased risk of maternal and fetal complications and managing the anticoagulation of these patients can be challenging. This case-based tutorial explores the peri-partum management of a woman with a prosthetic mitral heart valve who experiences complications following delivery. Management of pregnant women with mechanical heart valves – A case based discussion (214) - February 21, 2011

Acute pain is a fundamental part of anaesthetic practice with multiple neurochemical and psychological factors influencing its perception. The relevant anatomy and physiology are discussed in this tutorial.Acute pain management part 1 – Anatomy & physiology (213) - February 14, 2011

Antibiotic prophylaxis can have a large impact on reducing surgical site infections. This tutorial explores the microbiological basis for prophylaxis and presents up to date evidence for its rational use.Microbiology for Anaesthetists part 2 – Surgical Prophylaxis (212) - February 7, 2011

Based around a case report, this explores the presentation, aetiology and management of paediatric retropharyngeal abscessAnaesthetic management of Retropharyngeal abscess in Children (211) - January 31, 2011

Acute Coronary Syndrome places our patients at significant risk of perioperative myocardial infarction. This risk must be assessed thoroughly, anticipated and managed to prevent patient harm.Acute Coronary Syndromes (210) - January 24, 2011

H1N1: What it is and what to do when your patients have it.Intensive care management of pandemic (H1N1) Influenza (209) - January 17, 2011

Using ultrasound-guidance, the median and ulnar nerves can be easily blocked in the forearm and the radial nerve just above the elbow to provide analgesia for hand surgery, or to augment or expedite a more proximal brachial plexus block.Ultrasound guided local anaesthetic forearm blocks (208) - January 10, 2011

This tutorial aims to highlight the importance of VTE/PE in obstetric patients and to examine the major risk factors associated with VTE/PE in pregnancy. It provides recommendations on the safe management of labour and delivery for women on prophylactic or therapeutic anticoagulation. It will only briefly touch on issues related to the diagnosis and management of women with confirmed VTE/PE in pregnancy.Venous thromboembolism and obstetric anaesthesia (207) - November 29, 2010

Out-of-hospital cardiac arrest (OOHCA) kills 90% of its victims before they reach hospital. This tutorial discusses evidence from randomised controlled trials supporting the use of induced hypothermia in carefully groups to improve outcome.Management of out-of-hospital cardiac arrests with induced hypothermia (206) - November 22, 2010

This tutorial summarises some of the most important physiological consequences of anaesthesia - the effects on respiratory physiology.The effects of anaesthesia on respiratory function (205) - November 15, 2010

Enhanced recovery is a combination of elements of care for elective surgery which aims to optimise pre-operative preparation for surgery, avoid iatrogenic problems, minimise the stress response to surgery, speed recovery and return to normal function. Enhanced recovery after surgery (204) - November 8, 2010

The use of day surgery is increasing worldwide. This tutorial discusses the background principles and gives an overview of day surgery from a paediatric perspective, including organisational issues.Anaesthesia for day case paediatric surgery (203) - November 1, 2010

This is the third and final tutorial of the critical care microbiology series. It aims to cover healthcare-associated infections for which the ICU population is at specific risk, viz. ventilator-associated pneumonia and catheter-related bloodstream infections.Antibiotics in Critical Care 3 – Critical Care-associated infections (202) - October 25, 2010

The aim of this tutorial is to provide a basic recipe for carrying out an awake fibreoptic intubation, safely, in a patient whom you have assessed to have a predicted difficult airway.Awake fibreoptic intubation – the basics (201) - October 18, 2010

Discusses the physiological effects of arterial tourniquets and prevention and management of problems occuring as a result of their use.Arterial tourniquets (200) - October 11, 2010

Part one of this series examines the physical principles behind ultrasound. An understanding of this is important in interpreting ultrasound images.The physics of ultrasound – part 1 (199) - October 4, 2010

Rhabdomyolysis is the breakdown of striated muscle. There are many causes that all ultimately progress to myocyte necrosis and release of intracellular contents into the circulation. This can produce life-threatening complications including hyperkalaemia and acute kidney injury (AKI)Rhabdomyolysis (198) - September 27, 2010

This tutorial discusses the rare but potentially fatal topic of amniotic fluid embolus.Amniotic fluid embolism (197) - September 20, 2010

Cerebral Palsy is a disorder of posture and movement. This tutorial discusses related medical problems to allow careful perioperative management by the anaesthetist. Anaesthetic management of patients with cerebral palsy (196) - September 13, 2010

Rectus sheath catheters provide blockade of the anterior division of T6 - T11 thoraco-abdominal intercostal nerves for post-operative analgesia. This tutorial describes a technique of surgical placement of these catheters under direct vision. This can be a useful alternative to epidural block.Surgically placed rectus sheath catheters (195) - September 6, 2010

This tutorial discusses the aetiology and diagnosis of acute kidney injury and describes the management of this from conservative to renal replacement therapy.Renal replacement therapy in critical care (194) - August 30, 2010

The fascia iliaca compartment block is a low-skill, inexpensive method to provide peri-operative analgesia for surgery on the thigh, hip joint and/or the femur.Fascia Iliaca Compartment Block (193) - August 23, 2010

This tutorial covers the risk factors and pathophysiology of pulmonary aspiration of gastric contents, and goes on to discuss prevention and management.Pulmonary aspiration of gastric contents (192) - August 16, 2010

Acute Fatty Liver of Pregnancy is a rare but occasionally fatal disorder of late pregnancy. This tutorial discusses the pathophysiology, epidemiology and management of this condition and how prompt diagnosis and appropriate treatment has greatly improved the prognosis for both mother and babyFatty Liver of Pregnancy (191) - August 9, 2010

190 Microbiology for anaesthetists part 1 – Pharmacology of antibacterial and antiviral drugsMicrobiology for anaesthetists part 1 – Pharmacology of antibacterial and antiviral drugs (190) - August 2, 2010

In this tutorial we will cover the anaesthetic management of these patients in the pre-operative, intra-operative and post-operative periods, the surgical and anaesthetic techniques specific to pituitary surgery and the complications which may arise.The hypothalamic-pituitary axis part 2 – Anaesthesia for pituitary surgery (189) - July 26, 2010