P-Pa P 50 see Oxyhaemoglobin dissociation curve P value see Probability P wave Component of the ECG representing atrial depolarisation. Normally positive (i.e., upwards) in lead I, and best seen in leads II and V 1 ( see Fig. 60b ; Electrocardiography ). Maximal amplitude is normally 2.5 mm in lead II, and its duration 0.12 s (three small squares). In right atrial enlargement, the P wave is…

Ob-Oc Obesity Usually defined according to body mass index ( see Table 13 ; Body mass index ). Approximately 40% of UK adults are obese and this number has doubled in the last 20 years, although the rate of increase has slowed over the last ~15 years. The prevalence of severe obesity (‘morbid obesity’; BMI >40 kg/m 2 ) in the UK is 3%–4%. In the USA,…

Na-Nc Nabilone Cannabinoid antiemetic drug , acting on CB 1 and CB 2 cannabis receptors, used in chemotherapy-induced nausea and vomiting. Has also been used in palliative care . Dosage: 1–2 mg orally bd Side effects: drowsiness, ataxia, visual disturbances, sleep disturbances, hypotension, tachycardia. Nalbuphine hydrochloride Opioid analgesic drug and opioid receptor antagonist , synthesised in 1968. Partial agonist at kappa and sigma opioid receptors , and…

Ma-Md MAC see Minimal alveolar concentration Macewen, William (1847–1924). Eminent Scottish surgeon; Professor at Glasgow University, knighted in 1902. Advocated and practised tracheal intubation, usually oral, for laryngeal obstruction, e.g. due to diphtheria ; he performed this by touch without anaesthetic. Was the first to advocate tracheal intubation instead of tracheotomy for head and neck surgery, in 1880. The tube was inserted before introduction of chloroform…

La-Lb Labat, Gaston (1877–1934). Anaesthetist, born in the Seychelles; worked in Paris and at the Mayo Clinic and New York University, USA. Pioneer of regional anaesthesia, writing a classic text on the subject in 1922. Founded the American Society of Regional Anaesthesia in 1923. Brown DL, Winnie AP (1992). Reg Anesth; 17: 249–62 Labetalol hydrochloride Combined β- and α-adrenergic receptor antagonist , with ratio of activities…

Ka-Kc Kallikreins Serine protease enzymes in tissue and plasma, performing diverse physiological functions. Produce kinins from kininogens and may also catalyse formation of renin from prorenin. Plasma kallikrein is produced from prekallikrein by various activating substances, including part of activated coagulation factor XII. Plasmin, a fibrinolytic enzyme, catalyses the reaction, as does kallikrein itself. Inhibited by aprotinin . Prostate-specific antigen (PSA) is a kallikrein used as…

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Ib-Ic Ibandronic acid see Bisphosphonates Ibsen, Bjørn (1915–2007). Danish anaesthetist, considered by many to be the founding father of intensive care. Created a dedicated respiratory care unit for patients with poliomyelitis during the Copenhagen outbreak in 1952. Drastically cut mortality by employing positive pressure ventilation, mainly via tracheostomy. Opened the first general intensive care unit in 1953, a concept that was rapidly adopted worldwide. Richmond C…

H1-Ha H 2 receptor antagonists Competitive antagonists of H 2 histamine receptors. Used to reduce histamine-mediated gastric acid secretion in: peptic ulcer disease ; gastro-oesophageal reflux ; those at risk of aspiration of gastric contents ; and to reduce gastric/duodenal bleeding in patients in ICU. Their routine use in critically ill patients receiving enteral feeding is declining because they increase the risk of nosocomial chest infections.…

G-Ga G protein-coupled receptors (GPCRs). Family of transmembrane receptors with a broad range of ligands, including neurotransmitters and hormones. The target receptors of many drugs, including adrenaline and other catecholamines , opioids and antihistamine drugs . Consist of seven membrane-spanning helices bound on the inner surface of the membrane to a G protein, so called because they bind guanine diphosphate (GDP) and triphosphate (GTP). G proteins…

Fa-Fd F wave see Atrial flutter . Facemasks The traditional black antistatic rubber anaesthetic masks, with soft edges or inflatable rims, have largely been replaced by clear, disposable, plastic masks. Ideally, they should have minimal dead space and make an airtight seal with the patient's face. Some are malleable to improve fit. Damage may be caused to eyes, nose and face if excessive pressure is used.…

Ea-Eb Ear, nose and throat surgery (ENT surgery). Procedures vary from minor day-case surgery (e.g. myringotomy) to major head and neck dissections. Anaesthetic considerations: ◗ preoperatively: – airway obstruction may be present (often worse on lying flat), particularly in adults presenting with known or suspected tumours. Assessment of the airway in clinic using flexible nasendoscopy provides useful information. Potential difficulty with intubation/mask ventilation should be assessed.…

Dδ-Da δ wave see Wolff–Parkinson–White syndrome DA examination (Diploma in Anaesthetics). First specialist examination in anaesthetics; first held in 1935 in London. Originally intended for anaesthetists with at least 2 years' experience and 2000 anaesthetics, later reduced to 1 year's residence in an approved hospital. A two-part examination was introduced in 1947, becoming the FFARCS examination in 1953; the single-part DA remained separate until 1984, when…

C1-Ca C1-esterase deficiency see Hereditary angio-oedema CABG see Coronary artery bypass graft Cachectin see Cytokines Cachexia see Malnutrition Caesarean section (CS). Operative delivery of a fetus by surgical incision through the abdominal wall and uterus. Usually done via a transverse lower segment incision as this is associated with lower rates of ileus, infection and bleeding than the classic midline upper uterine segment approach. The CS rate…

Ba-Be BACCN see British Association of Critical Care Nurses Backward failure see Cardiac failure Baclofen Synthetic GABA B receptor agonist and skeletal muscle relaxant, used to treat muscle spasticity, e.g. following spinal injury and in multiple sclerosis. Acts at both spinal and supraspinal levels. Has also been used to treat alcohol withdrawal syndromes . Dosage: 5 mg orally tds, increased slowly up to 100 mg Has also been…

Aa-Ab A severity characterisation of trauma (ASCOT). Trauma scale derived from the Glasgow coma scale , systolic BP, revised trauma score , abbreviated injury scale and age. A logistic regression equation provides a probability of mortality. Excludes patients with very poor or very good prognoses. Has been claimed to be superior to the trauma revised injury severity score system, although is more complex. Champion HR, Copes…