By Ian Johnston, William Harrop-Griffiths, Leslie Gemmell
Based at the organization of Anesthetists of significant Britain and Ireland's (AAGBI) carrying on with schooling lecture sequence, this clinical-oriented e-book covers the most recent advancements in study and the scientific program to anesthesia and ache control.
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Extra resources for AAGBI Core Topics in Anaesthesia 2012
Three-dimensional ultrasound makes real life images of the fetus possible in colour. Pulsed Doppler mode shows an image with velocity on the y axis and time on the x axis. Basic Doppler images are presented in red and blue, not a greyscale. The colour does not indicate the oxygenation of the blood or the direction of flow. Flow towards the transducer is usually shown as a positive value. The safety of ultrasound There are two potential ways in which ultrasound can damage tissue: thermal injury and cavitation.
Using the equation below, it can be calculated that about 1% of the sound wave is reflected from interfaces between soft tissues and the rest of the wave passes on to the next depth. where Z1 = the first tissue and Z2 is the second tissue. A substance with high acoustic impedance is a good reflector of sound. The strength of the signal reflected back when the sound wave moves from one substance to another depends on the acoustic impedance. The ratio (R) of the reflected to the incident amplitude, also known as the amplitude reflection coefficient, is < 1% for most tissue interfaces, so most of the sound is transmitted through the interface.
Technology Availability Use Intra-aortic balloon pump Widespread Haemodynamic support in patients with critical myocardial ischaemia or cardiogenic shock Intravascular Ultrasound (IVUS) Widespread Gives details of vessel size. Excellent images of stents, particularly useful in guiding post-dilatation or in acute stent thrombosis Pressure wire / FFR Widespread Measures pressure within the coronary artery. When coupled with adenosine challenge, can give measure of functional significance of a lesion Rotablation Widespread Used to debulk coronary arteries before stenting Laser Limited Used to debulk coronary arteries before stenting Brachytherapy Limited Use of radiation therapy for the treatment of recurrent in-stent restenosis Optical Coherence Tomography (OCT) Emerging technology Uses light rather than ultrasound – excellent visualisation of intra-arterial structure and stents but poor tissue penetration Acute stent thrombosis This complication has a 20–40% mortality, and is often due to a mechanical problem with the stent such as malapposition of a stent strut or strut fracture.