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Neurobiological mechanisms of central sensitisation underlying chronic pain states

BJA Education @bjaeducation.bsky.social · 1d

🔍 Why does pain persist when the injury is gone? Central sensitisation offers an answer — neural circuits adapt, amplify, and reorganise, sustaining chronic pain. Read more in #BJAEd: www.bjaed.org/article/S205...

Chronic pain, whether primary and recognised as a disease in its own right, or secondary to another disease, is associated with a persistent amplification of the painful experience, which explains…

Anaesthesia for non-cardiac surgery in patients with adult congenital heart disease

BJA Education @bjaeducation.bsky.social · 2d

Not all ACHD patients carry the same risk ⚖️ Classifying by anatomical complexity & physiological status is key for safe periop planning 🧠 Full breakdown in #BJAEd: www.bjaed.org/article/S205...

Congenital heart disease (CHD) is the most common group of congenital anomalies, with a prevalence of approximately nine per 1000 live births. Advances in medical and surgical care have significantly…

Grading systems for tracheal intubation using videolaryngoscopy

BJA Education @bjaeducation.bsky.social · 3d

📘 Videolaryngoscopy is now central to safe airway management – but are we still documenting it with tools built for a different era? This article questions whether Cormack–Lehane should finally be retired for VL. #BJAEd www.bjaed.org/article/S205...

The first videolaryngoscopes were marketed in 2001. In the two decades since, the number of models available, diversity in design and popularity have all significantly increased.1 Designs can be…

Ventilator-associated pneumonia

BJA Education @bjaeducation.bsky.social · 4d

🌍 Ventilator-associated pneumonia (VAP) varies widely between regions — but why? Definitions, diagnosis & practice all play a role. A must-read review in BJA Education. #BJAEd www.bjaed.org/article/S205...

Ventilator-associated pneumonia (VAP) is a common complication of invasive ventilation that afflicts critically ill patients and is associated with increased morbidity and mortality. However, it is…

Major trauma in the elderly: unique challenges and considerations

BJA Education @bjaeducation.bsky.social · 5d

Major trauma is shifting. 🚑 The “typical” patient is now in their 60s, often with frailty & comorbidities. How should anaesthetists adapt to this new reality of silver trauma? Read more in #BJAEd: www.bjaed.org/article/S205...

In England there are around 60 cases of major trauma (Injury Severity Score (ISS) > 15) daily.1 Trauma continues to be the leading cause of death in children and adults aged <40 years and has…

Neurobiological mechanisms of central sensitisation underlying chronic pain states

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BJA Education @bjaeducation.bsky.social · 6d

Chronic pain isn’t always about structural damage. 🧠 Central sensitisation reshapes the nervous system, amplifying pain signals for a long time. Explore the mechanisms behind this phenomenon in #BJAEd: www.bjaed.org/article/S205...

Chronic pain, whether primary and recognised as a disease in its own right, or secondary to another disease, is associated with a persistent amplification of the painful experience, which explains…

Anaesthesia for non-cardiac surgery in patients with adult congenital heart disease

BJA Education @bjaeducation.bsky.social · 7d

Patients with adult congenital heart disease (ACHD) are living longer 🫀➡️ increasing presentations for non-cardiac surgery. What does this mean for perioperative risk, planning & anaesthesia? 📘 New #BJAEd review. www.bjaed.org/article/S205...

The dates displayed for an article provide information on when various publication milestones were reached at the journal that has published the article. Where applicable, activities on preceding…

doi.org

BJA Education @bjaeducation.bsky.social · 13d

📈 CLIF-C ACLF score is more predictive of mortality than MELD or Child–Pugh.
It incorporates organ failure, age & WCC.
Key for prognosis & decision-making.
👉 Check out the table in this month’s BJA Education.
www.bjaed.org/article/S205...

Acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is a distinct clinical entity from both acute liver failure and simple decompensation in chronic liver disease. Acute-on-chronic liver failure involves chronic…

Neurophysiology of acute and chronic pain: from genes to pain symptoms

BJA Education @bjaeducation.bsky.social · 14d

⚡Peripheral nociception → spinal cord → supraspinal centres

Feedback loops (neuroimmune, neuroendocrine)
= sensory + emotional + behavioural experience.
Pain is more than just a signal.

👉 www.bjaed.org/article/S205...

As the earliest writings of ancient civilisations attest, pain has been an unceasing challenge for humanity. This sensory and emotional experience is essential if we are to live in good health. It…

BJA Education @bjaeducation.bsky.social · 15d

🛠️ What would your ideal pre-hospital bag contain?
Equipment matters:
• Portable, robust, checked daily
• 2nd-gen supraglottic devices preferred
• Videolaryngoscopes = primary tool in most UK prehospital services
Kit reliability = patient safety.
Read more: www.bjaed.org/article/S205...

Poor airway management is a significant cause of morbidity and mortality in patients suffering major trauma. In 2007 a National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report…

BJA Education @bjaeducation.bsky.social · 16d

🔍 Identify unique features of ICU airway management.
Critically ill patients have physiologically difficult airways due to hypoxaemia, shock, and poor reserve—very different from elective theatres.
Full article 👉 www.bjaed.org/article/S205...
#ICU #AirwayManagement

Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg…

BJA Education @bjaeducation.bsky.social · 17d

🔑 In major trauma, the priority is a patent airway + adequate oxygenation.
Suspected unstable cervical spine injuries are rare, and airway takes precedence.
Read more: www.bjaed.org/article/S205...
#Prehospital #AirwayManagement

Poor airway management is a significant cause of morbidity and mortality in patients suffering major trauma. In 2007 a National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report…

Anaesthesia for children with DNA repair disorders

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BJA Education @bjaeducation.bsky.social · 18d

⚠️ Ataxia telangiectasia:
• Neurodegeneration & ataxia
• Immunodeficiency → recurrent infections
• Aspiration risk from dysphagia
• Radiosensitivity & ↑ cancer risk
Anaesthesia requires specialist centre care + careful aspiration & infection assessment.
👉 www.bjaed.org/article/S205...

DNA repair disorders are caused by genes involved in DNA mutation detection and repair mechanisms. These disorders have diverse phenotypes which manifest at birth or early childhood. Although…

Neurophysiology of acute and chronic pain: from genes to pain symptoms

BJA Education @bjaeducation.bsky.social · 19d

🧠 Pain is multidimensional: sensory, emotional, cognitive & behavioural.
It results from an imbalance between excitatory and inhibitory control in nociceptive circuits.
This month’s BJA Education explores pain from genes to symptoms.
👉 www.bjaed.org/article/S205...

As the earliest writings of ancient civilisations attest, pain has been an unceasing challenge for humanity. This sensory and emotional experience is essential if we are to live in good health. It…

BJA Education @bjaeducation.bsky.social · 20d

🫀 Haemodynamic collapse after ICU intubation: remember all the key mechanisms.
• Hypovolaemia
• LV/RV dysfunction
• Drug-induced vasodilation
• Transition to positive pressure ventilation
Optimise fluids & vasopressors early.
#Airway #ICU
👉 www.bjaed.org/article/S205...

Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg…

Acute-on-chronic liver failure

BJA Education @bjaeducation.bsky.social · 21d

⚖️ Rebalanced coagulation

Patients may bleed or clot in acute liver failure.
Routine correction of INR with products isn’t recommended unless bleeding.
Viscoelastic testing can help guide therapy.
Read more in BJA Education: www.bjaed.org/article/S205...
#CriticalCare #Haemostasis

Acute-on-chronic liver failure (ACLF) is a distinct clinical entity from both acute liver failure and simple decompensation in chronic liver disease. Acute-on-chronic liver failure involves chronic…

BJA Education @bjaeducation.bsky.social · 22d

🌦️ Environmental factors play a huge role in the pre-hospital arena:
• Weather, noise, lighting
• Distance to major trauma centres
• Scene safety & hazards
Each shapes airway management decisions in the field.

Read more: www.bjaed.org/article/S205...

Poor airway management is a significant cause of morbidity and mortality in patients suffering major trauma. In 2007 a National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report…

Neurophysiology of acute and chronic pain: from genes to pain symptoms

1 2

BJA Education @bjaeducation.bsky.social · 23d

🔍 Pain neuromatrix: Melzack’s theory proposes pain emerges from a dynamic network of brain structures.
Below shows sensory, affective & cognitive dimensions.
Not one centre—but a mosaic of systems.
👉 www.bjaed.org/article/S205...

As the earliest writings of ancient civilisations attest, pain has been an unceasing challenge for humanity. This sensory and emotional experience is essential if we are to live in good health. It…

BJA Education @bjaeducation.bsky.social · 24d

🫁 Optimising oxygenation is key: there are many variables affecting preoxygenation.
👉 FRC, FiO₂, patient position, agitation, sepsis, pain.
Safe apnoea time is often very short—positive pressure preoxygenation extends it.
Read more: www.bjaed.org/article/S205...

Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg…

BJA Education @bjaeducation.bsky.social · 25d

⚖️ Pain depends on the balance of excitation & inhibition.
⬆️ Excitation → hyperalgesia, allodynia
⬆️ Inhibition → analgesia
This month’s BJA Education article highlights key mediators: glutamate, GABA, opioids, serotonin, cannabinoids.

👉 www.bjaed.org/article/S205...

BJA Education @bjaeducation.bsky.social · 26d

📋 Checklists save lives.
Pre-hospital checklists improve outcomes → fewer failed intubations & more first-pass success.
Verbal challenge-response format builds shared mental models.
Read more: www.bjaed.org/article/S205...

Poor airway management is a significant cause of morbidity and mortality in patients suffering major trauma. In 2007 a National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report…

Acute-on-chronic liver failure

BJA Education @bjaeducation.bsky.social · 27d

💉 Albumin isn’t just volume replacement in acute on chronic liver failure.
It binds toxins, reduces oxidative stress & may modulate inflammation.
Used in SBP, HRS, AKI, & post-paracentesis.
Evidence is evolving - read more in the BJA Education: www.bjaed.org/article/S205...

Acute-on-chronic liver failure (ACLF) is a distinct clinical entity from both acute liver failure and simple decompensation in chronic liver disease. Acute-on-chronic liver failure involves chronic…

BJA Education @bjaeducation.bsky.social · 27d

💉 With emergency intubations in intensive care, drug choice matters!
Propofol = independent risk factor for collapse (used in 41.5% of ICU intubations).
Guidelines suggest ketamine or etomidate as preferred agents in the critically ill.
Full summary: www.bjaed.org/article/S205...

Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg…

Anaesthesia for children with DNA repair disorders

BJA Education @bjaeducation.bsky.social · 28d

🧬 DNA repair disorders in children—rare but clinically significant.
They include ataxia telangiectasia, Cockayne syndrome & Fanconi anaemia, each with unique perioperative risks.

This month’s BJA Education reviews key anaesthetic considerations.
👉 www.bjaed.org/article/S205...

DNA repair disorders are caused by genes involved in DNA mutation detection and repair mechanisms. These disorders have diverse phenotypes which manifest at birth or early childhood. Although…