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Talk:Thrombotic thrombocytopenic purpura

Untitled
Has this page been closed to editing? The Symptoms and diagnosis sections don't appear on the editing page.

In any case someone should add "Schistocytes" as an alternative spelling of "Schizocytes".

Relation with contraception
Both references that were included for the statement that there is a relation between anticonception use and TTP conclude that: a causal relationship between progestogen-only contraceptives and TTP is not established by the data presented. So I don't think it should be included in this article unless new hard evidence becomes available. The first study also had some follow-up letters disputing its claims. The references: --WS 05:14, 15 January 2006 (UTC)

 * While I agree with you that causality has never been proven, I think that the controversy is sufficiently important (and interesting) that it should be mentioned somewhere in the article. Mgmei 05:21, 15 January 2006 (UTC)

 * A total of 3 reported cases ever worldwide is hardly even controversial. The reported rate was not even higher than in women who didn't use norplant. It was the authors estimation (no evidence given) that it was underreported and therefore the actual rate could be actually higher. If you really want to add that to the article that's fine with me, but choose your words carefully and certainly don't state it as a fact and also for nothing else than norplant. --WS 05:35, 15 January 2006 (UTC)

I agree with WS here. Just because TTP is rare does not mean all theoretical links should be farmed out over here. Ticlopidine, now that's a different matter. JFW | T@lk  14:15, 16 January 2006 (UTC)

Ehlichiosis
has inserted material to reflect that Ehlichiosis can cause TTP, or at least a TTP-like picture. The problem is - if it is a microangiopathic haemolytic anaemia due to Ehrlichiosis it is by definition not TTP. I cannot disagree that Ehlichia serology will need to be considered in patients presenting with haemolysis, but that not be mentioned here. Oddly, does not even mention red cell fragments as characteristic for TTP, nor do any other of the three case reports available on pubmed that mention TTP as a differential. Reviewing  yielded those same reports.

Wikipedia needs to be selective in its medical content. It cannot possibly list all diseases, mimics, differential diagnoses and so on. When mentioning diseases as mimics/differentials, a small number of case reports is generally insufficient, however meaningful the association to one particular person.

If this is not agreeable, please leave a message on WP:CLINMED. Perhaps my colleagues disagree with my assessment. JFW | T@lk  22:36, 18 December 2006 (UTC)

From my talk page: David Ruben Talk 02:32, 23 December 2006 (UTC)

No, it is a human disorder as well, the entry for it in Wikipedia is just plain ridiculous, look at the CDC website for a good one. I keep meaning to update WIki because although it does affect dogs its human pathology is more important. The incidence of human Ehrlichiosis 1000 cases per million as opposed to TTP 3-6 pre million, hence my personal belief that it may be underdiagnosed especially because even in fatal cases it is seronegative half the time and because doctors tend NOT to have heard of it!!!!!!!!!!!! I wish you would have kept that in. I had ehrlichiosis and hemolytic anemia after moving into my house at the base of NIsene Mark State Park which in 2003 San Jose State Entomologists found had not only the highest Lyme MIR in all of California 17.8% in adult ticks but also HIGH levels of the causative agents of both HME and HGE Human Granulytic and Human Monocytic Ehrlichiosis (I had HME) up to 13.3% in ticks. In my house a couple decades ago a 16 year old girl named Wendy Ann Hunter died of "peripheral vascular collapse" and meningitis- I got a copy of her death certificate after her mother stopped by our house when we were having a yard sale and told us about her. "This is the last place I remember my duaghter alive." ALSO our babysitter down the street Juniper was diagnosed TTP with a history of Lyme disease,(the preceding is why I care) but her doctor REFUSED TO TEST HER FOR EHRLICHIOSIS!!!

 * Safdar N, Love RB, Maki DG. Severe Ehrlichia chaffeensis infection in a lung transplant recipient: a review of ehrlichiosis in the immunocompromised patient. Emerg Infect Dis. 2002 Mar;8(3):320-3. Review.
 * Modi KS, Dahl DC, Berkseth RO, Schut R, Greeno E. Human granulocytic ehrlichiosis presenting with acute renal failure and mimicking thrombotic thrombocytopenic purpura. A case report and review. Am J Nephrol. 1999;19(6):677-81.
 * Marty AM, Dumler JS, Imes G, Brusman HP, Smrkovski LL, Frisman DM. Ehrlichiosis mimicking thrombotic thrombocytopenic purpura. Case report and pathological correlation. Hum Pathol. 1995 Aug;26(8):920-5.
 * Am J Trop Med Hyg. 2001 Nov;65(5):603-9. Tissue diagnosis of Ehrlichia chaffeensis in patients with fatal ehrlichiosis by use of immunohistochemistry, in situ hybridization, and polymerase chain reaction. Dawson JE, Paddock CD, Warner CK, Greer PW, Bartlett JH, Ewing SA, Munderloh UG, Zaki SR. Publication Types:Case Reports  "In the United States, human ehrlichiosis is a complex of emerging tick-borne diseases caused by 3 distinct Ehrlichia species: Ehrlichia chaffeensis, Ehrlichia ewingii, and the human granulocytotropic ehrlichiosis agent. Ehrlichioses are characterized by a mild to severe illness, and approximately 4% of cases are fatal. Because these obligate intracellular bacteria are difficult to resolve with routine histologic techniques, their distribution in tissues has not been well described. To facilitate the visualization and detection of ehrlichiae, immunohistochemistry (IHC), in situ hybridization (ISH), and polymerase chain reaction (PCR) assays were developed by use of tissues from 4 fatal cases of E. chaffeensis infection. Evidence of E. chaffeensis via IHC, ISH, and PCR was documented in all 4 cases. Abundant immunostaining and in situ nucleic acid hybridization were observed in spleen and lymph node from all 4 patients. Significantly, in 2 of these patients, serologic evidence of infection was absent. Use of IHC, ISH, and PCR to visualize and detect Ehrlichia in tissues can facilitate diagnosis of ehrlichial infections. "
 * —Preceding unsigned comment added by CaliforniaLyme (talk • contribs) 15:35, 21 December 2006

 * You comment above"hence my personal belief that it may be underdiagnosed especially..."', your are entitled to an opinion of course, and as such open-up discussion on an article and what it does or does not cover. However "my personal belief" counts as original research and thus has no place (irrespective whether right or wrong) in an article under WP:No original research guidelines. Instead one must find WP:reliable sources that give such opinions.
 * Your discussion above focuses on ehrlichiosis in the US, yet wikipedia is not an Amercican health manual but has worldwide perspective.
 * The links above I agree confirm that the condition may superficial appear somewhat similar in some cases, but this makes it a differential in certain cases, not all cases of apparent TTP. Also it is not a cause of TTP itsef. states "with features of thrombotic thrombocytopenic purpura" this is not stating that TTP is caused by ehrlichiosis, just that it has some appearances that appear similar - i.e. separate condition which might coexist on a list of differentials for a given clinical presentation, but they are not being equated as the same.  discusses "Ehrlichiosis mimicking TTP" and likewise in title of, so making this a differential in certain circumstances, but not cause.
 * In conclusion I think any mention of Ehrlichia is something that ought to be outside of main testing section, and in perhaps a subsection dealing exclusively with the local issues (on a global scale) found in some parts of the US. David Ruben Talk 02:32, 23 December 2006 (UTC)

 * I see CaliforniaLyme has created Ehrlichiosis Induced TTP Mimic. this is wrongly capitalised, poorly phrased title that also is inappropriate as its own article (info should be under the article Ehrlichiosis). See Talk:Ehrlichiosis for discussion. David Ruben Talk 02:53, 23 December 2006 (UTC)

Duplicate information
Somebody added a "history" section which basically attempted to cover all pathological aspects as well. Much of that was duplicate with other sections. I have moved it here; if there is anything that the article does not presently cover it can be moved back. For one thing, it makes numerical claims without reliable sources. JFW | T@lk  09:49, 14 January 2007 (UTC)

 * This life-threatening condition may have positive outcomes if recognized early and if medical intervention is initiated early. With the introduction of plasma exchange, the survival rate has improved from approximately 3% prior to the 1960s to 82%. Early plasma exchange initiation has beneficial outcomes.

 * TTP was once thought to have the same mechanism of disease as hemolytic-uremic syndrome (HUS), the other major thrombotic microangiopathy. However, more recent findings suggest that TTP is a different entity than HUS. They are closely related disorders and are characterized by microvascular lesions with platelet aggregation. HUS is more common in children and is caused by strains of enterohemorrhagic Escherichia coli, especially E coli O157:H7 carrying the Shigalike toxin. HUS is characterized by prominent renal involvement. TTP is associated with pregnancy; diseases such as HIV, cancer, bacterial infection, and vasculitis; bone marrow transplantation; stem cell transplantation; and drugs.

 * In most cases of familial TTP and acquired idiopathic TTP, the endothelial cells secrete and release the ultralarge (UL) von Willebrand factor (ULVWF) multimers. The sheer stress of fluid and platelet thrombi in the microcirculation should enhance proteolysis of ULVWF. The agitated endothelial cells are the main source of ULVWF multimers in the bloodstream where they bind to specific surface platelet receptors. In 1982, Moake et al showed that the ULVWF multimers were unusually large in patients with chronic relapsing TTP. ULVWF multimers entangle with platelets adhering to the subendothelium. Two independent research groups reported a lack of ULVWF-cleaving protease activity in the blood of patients with TTP. The lack of ULVWF-cleaving protease activity was suggested to be due to the presence of antibodies or a severe deficiency of ULVWF-cleaving protease.

 * The ULVWF multimers are cleaved by ADAMTS-13 as they are secreted from endothelial cells. Failure to degrade the ULVWF multimers is believed to cause the familial and acquired idiopathic types of TTP. The ULVWF-cleaving protease, ADAMTS-13, is inhibited by the production of autoantibodies in acquired idiopathic TTP and ADAMTS-13 gene mutations in familial TTP causing inactivity or decreased activity of ADAMTS-13. Furlan et al found in their investigation, including retrospective analysis of plasma samples, that an autoimmune mechanism may be responsible in patients with acquired deficiency of the ULVWF-cleaving protease, whereas patients with the familial form have complete protease deficiency. In TTP, insufficiency of ADAMTS-13 may be the key component in the pathogenesis of ULVWF multimer–induced platelet thrombosis.

 * TTP differs from HUS by having a deficiency in ULVWF-cleaving protease ADAMTS-13 activity not found in HUS, and HUS has sufficient uninhibited protease. The intervention of plasma exchange is ineffective because its role is to remove antibodies and replace VWF-cleaving protease. Differentiating TTP from HUS benefits the patient because plasma exchange is not a benign intervention. This differentiation also saves costs and time. Research is ongoing, but, presently, TTP is suggested to be a different entity than HUS.

 * ULVWF multimers are abundant and fibrinogen/fibrin is minimal in TTP, whereas fibrinogen/fibrin is abundant in disseminated intravascular coagulation (DIC). The ULVWF multimer is a marker found in the plasma of patients most likely to have a recurrence of TTP.

 * Other interactions, both transcellular and intercellular, are suggested in TTP, including various combinations of platelets, leukocytes, erythrocytes, and endothelium. These interactions may be the key stimuli in the initiation of cell activity and morphological changes that occur in TTP.

Mouse model
Both ADAMTS13 and VWF are needed for an experimental model of shiga toxin-induced TTP (http://bloodjournal.hematologylibrary.org/cgi/content/abstract/111/7/3452). JFW | T@lk  00:49, 25 March 2008 (UTC)

Expert Attention Needed?
This article seems a bit confusing. Maybe it needs expert attention...

The DarkArcher was here (talk) 01:47, 24 June 2008 (UTC)

 * Yeah, great. You find an expert in TTP ready to make contributions to this article. For the moment you've got to do with me and possibly . JFW | T@lk  16:10, 1 July 2008 (UTC)
 * I have to say reading this article makes me feel like i know less than i did before i looked it up--02:56, 22 October 2008 (UTC) —Preceding unsigned comment added by Shimonnyman (talk • contribs)

Sadler
Excellent historical review from the great JE Sadler: http://bloodjournal.hematologylibrary.org/cgi/content/abstract/112/1/11 JFW | T@lk  16:10, 1 July 2008 (UTC)

Management
I don't think the treatment section is going to be any good without working this review into the article: http://content.nejm.org/cgi/content/short/354/18/1927 JFW | T@lk  22:12, 13 July 2008 (UTC)

Mnemonic
Hey guys, Im new to editing wikipedia articles. I'd like to put in the mnemonic "FATRN" which is a way to remember the pentad of TTP: Fever Anemia (hemolytic) Thrombocytopenia Renal failure Neuro symptoms — Preceding unsigned comment added by 24.203.220.148 (talk • contribs)

 * We don't usually put mnemonics on Wikipedia, because they are often very local (USA vs UK), have little value for the reader unless that reader happens to be a medical student, and so on. See WP:MEDMOS for more details. In this instance, I'd need a mnemonic to remember the mnemonic! JFW | T@lk  06:29, 28 June 2011 (UTC)

Delete table?
There is a table in the article about various conditions (but not TTP) and associated coagulation abnormalities - tangentially related, but not really relevant or informative about TTP. I think it should be deleted. Thoughts on this? Wawot1 (talk) 04:38, 6 January 2012 (UTC)

 * It's gone. I agree. JFW | T@lk  23:15, 7 January 2012 (UTC)

Expert
I have an expert who has given this a lot of attentiong- made the changes and added references. I am here to edit the page and I cannot figure out how to fix the reference section and then go on get the footnotes and citations working correctly. Do you have to edit the references within the article itself or can you start with the reference list? — Preceding unsigned comment added by Dr.Lieberman (talk • contribs) 16:56, 3 January 2013 (UTC)

 * Citations are placed inline after the material covered by them. Click here for more details.Novangelis (talk) 17:30, 3 January 2013 (UTC)

 * I have already directed this user to WP:CITE. Can I also point out that references for medical articles should meet the criteria outlined in WP:MEDRS? Small case series or trials are not suitable as references. JFW | T@lk  20:26, 3 January 2013 (UTC)

British review
10.1111/bjh.12718, practical aspects of treatment. The UCH service reputedly treats more TTP than any other centre in the world. JFW | T@lk  13:25, 9 January 2014 (UTC)

 * 10.1182/blood-2014-11-611335 Oklahoma folk have summarised the evidence for drug-induced TMA. JFW | T@lk  21:46, 25 January 2015 (UTC)

Pathophysiology
The Evan Sandler has written in Blood 10.1182/blood-2017-04-636431 JFW | T@lk  14:13, 8 September 2017 (UTC)

 * And another: 10.1111/jth.13956 JFW | T@lk  12:57, 11 April 2018 (UTC)

Critical care management
22 page expert statement 10.1007/s00134-019-05736-5 JFW | T@lk  15:46, 4 November 2019 (UTC)

ISTH criteria
10.1111/jth.15006 JFW | T@lk  22:38, 23 July 2020 (UTC)

 * ... and treatment guidelines 10.1111/jth.15010 JFW | T@lk  22:40, 23 July 2020 (UTC)

Good practice statements: 10.1111/jth.15009 JFW | T@lk  14:45, 18 September 2020 (UTC)


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Kudu

The kudus are two species of antelope of the genus Tragelaphus:

The two species look similar, though greaters are larger than lessers. A large adult male greater kudu stands over 5 ft tall at the shoulder, and a large male lesser kudu stands about 4 ft tall. Males of both species have long horns, which point upward and slightly back, curling in a corkscrew shape.
 * Lesser kudu, Tragelaphus imberbis, of eastern Africa
 * Greater kudu, Tragelaphus strepsiceros, of eastern and southern Africa

Etymology
The name of the animal was imported into English in the 18th century from isiXhosa iqhude, via Afrikaans koedoe.

Kudu, or koodoo, is the Khoikhoi and seTswana name (Tholo is the Setswana name) for this antelope. Tragos (Greek) denotes a he-goat and elaphos (Greek) a deer. Strepho (Greek) means "I twist", and strephis is "twisting". Keras (Greek) means "horn".

Habitat
Lesser kudus occupy savanna near Acacia and Commiphora shrubs. They rely on thickets for protection, so they are rarely seen in the open. Their brown and striped pelts help to camouflage them in scrub environments.

Behavior
As in many other antelopes, male kudus can be found in bachelor groups, but they are more likely to be solitary. Their dominance displays tend not to last long and are generally fairly peaceful, consisting of one male making himself look big by making his hair stand on end. When males do have a face-off, they will lock their horns in a competition to determine the stronger puller; kudus' necks enlarge during the mating season for this reason. Sometimes two competing males are unable to unlock their horns and, if unable to disengage, will die of starvation or dehydration. Males are seen with females only in the mating season, when they join in groups of 5–15 kudus, including offspring. Calves grow quickly and at six months are largely independent of their mothers.

A pregnant female will leave the herd to give birth to a single offspring. She will leave the newborn lying hidden for 4–5 weeks while coming back only to nurse it, which is the longest nursing period of any antelope species. Then the calf will start accompanying its mother for short periods. At 3 or 4 months, the calf will be with its mother constantly, and at about six months they will rejoin the group.

When threatened, kudu will often run away rather than fight. Wounded bulls have been known to charge an attacker, hitting the attacker with their sturdy horn base rather than stabbing it. Wounded females can keep running for many miles without stopping to rest for more than a minute. They have a powerful kick and are capable of breaking a wild dog's or jackal's neck or back. They are good jumpers and can clear a 5-foot fence from a standing start.

Diet
Kudus are browsers and eat leaves and shoots. In dry seasons they eat wild watermelons and other fruit for their liquid content and natural sugars. The lesser kudu is less dependent on water sources than the greater kudu.

Predators and threats
Predators, such as lions, leopards, cheetahs, wild dogs, hyenas, crocodiles and sometimes pythons, hunt adult kudu or their young. Kudu numbers are also affected by humans hunting them for their meat, hides and horns, or using their habitats for charcoal burning and farming.

Kudus were highly susceptible to the rinderpest virus (now eradicated after a vaccination program in domestic cattle), and many scientists believe that, in earlier times, recurring epidemics of the disease reduced kudu populations in East Africa.

Kudus are susceptible to rabies in times of extended drought. They have been known to enter farm houses and other buildings when infected. Infected animals appear tame and have a distinct frothing at the mouth. Rabid kudu are fearless, and bulls may sometimes attack humans who get too close.

Meat
Kudu meat is similar to venison (deer), with a slight gamey, liver-like flavor. It is a very dry and lean meat, so it needs to be cooked carefully to avoid drying it out.

In music and culture
A kudu horn is a musical instrument made from the horn of the kudu. A form of it is sometimes used as a shofar in Jewish ceremonies. It is seen in the Western world in its use as a part of the Scouting movement's Wood Badge training program; the sounding of the horn signals the start of a Wood Badge training course or activity. A horn of this shape, when used by football fans, is called kuduzela (a portmanteau of "kudu" and "vuvuzela").

The kudu, "tholo" in the languages of Sepedi, Setswana and Venda, is a tribal totem of the Barolong and Batlhaping people of Botswana and South Africa.

In the sport of kudu dung-spitting, contestants spit pellets of kudu dung, with the farthest distance (including the roll) reached being the winner. The sport is mostly popular among the Afrikaner community in South Africa, and a world championship is held each year.

Kudu-hunting is prominently featured in Ernest Hemingway's nonfiction book Green Hills of Africa, an account of a month-long safari he and his then-wife, Pauline Pfeiffer, went on in East Africa in December 1933.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Kudu


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Kuzu

The Kuzu (国栖・国巣・国樔) were a people of ancient Japan believed to have lived along the Yoshino River in Nara Prefecture. They were mentioned in the Kojiki and Nihon Shoki. The name was also used for a population living in the old Hitachi province (today's Ibaraki Prefecture) mentioned by the Hitachi Fudoki.

Their name may be at the origin of the name of the kudzu plant, supposedly for being associated with the harvest and sale of kudzu roots or starch extracted from them.

title: Kuzu


text:
Talk:Anesthesia

Emergence Phenomenon?
I was redirected to this page from Emergence Phenomenon, but emergence phenomena are not discussed on this page at all! —Preceding unsigned comment added by 72.207.77.105 (talk) 16:42, 18 September 2008 (UTC)

Likewise. Checking the original article's history I found a definition for Emergence Phenomenon as "In medicine, emergence phenomena are reactions experienced by patients during or after awakening from anaesthesia". Perhaps it would be more useful to redirect that page to a link in Wiktionary for this term? Either that, or please include the definition of the term on the Anesthesia page! --Fjb3 (talk) 00:29, 17 May 2009 (UTC)

 * And same here. It would be helpful if this term was explained. —Robotech_Master (talk) 03:03, 25 August 2009 (UTC)

 * It's still not mentioned in the page. Even a copy paste of the definition here would be nice in the page. 129.21.75.21 (talk) 20:22, 15 October 2009 (UTC)

 * I have added a (very) brief section describing emergence phenomena in the general anaesthesia article, which is a more appropriate place for that discussion than in this article IMHO. I have also rewritten the disambiguation page for emergence. I hope this helps. DiverDave (talk) 04:08, 27 December 2010 (UTC)

More vandals.
To those who are now attempting to edit the CRNA section to reflect YOUR politics, (anonymous IPs), it has been mandated by the staff of wiki that no changes are to be made without discussion here and agreement. I am the default protector of the CRNA section in this wiki entry and keep it from being politicized by ASA peons. Please, keep YOUR politics out of my section. Thanks,Mmackinnon (talk) 02:20, 15 June 2009 (UTC)

 * Editing an article by adding sourced information and removing unsourced information is not vandalism, but good editing. Claiming the article should remain as you left it is ownership, and violates wikipedia policy [].  If you and your sockpuppets are willing to have adult conversations and compromises on language that is one thing, crying vandalism everytime someone adds to an article you believe you own is another.  Fuzbaby (talk) 01:27, 16 June 2009 (UTC)

info for fuzbaby
Hello there

First, I am always suspicious (after 3 years) of people who come here making random edits without using the talk page. It suggests ulterior motives. Having said that, here is the reason why your edit is incorrect.

You had edited "CRNAs do not require Anesthesiologist supervision in any state and require surgeon/dentist/podiatrists to sign and approve the chart for medicare billing in all but 16 states. Many states place restrictions on practice, and hospitals often regulate what CRNAs can or can not do."

Here is what was stated previously: "CRNAs do not require Anesthesiologist supervision in any state and only require surgeon/dentist/podiatrists to sign the chart for medicare billing in all but 16 states."

The difference here is significant. First, noone is required to "approve" anything a CRNAs does by law or state law. Hospital policy may be different in each hospital as it IS for all physicians as well. So that statement, which makes the suggestion that CRNAs are somehow limited in comparison, is not needed since it also applies to physicians. In otherwords, it goes without saying. CRNAs are not the same an NPs in that regard. Second, the requirement to sign the chart ONLY exists as a CMS requirement for billing. In every state in the union CRNAs work independently in ASCs like plastic surgery centers, where it is an all cash buisness and CRNAs require noone to sign their chart. There is no "approval" of anything the CRNA does by a physician. This is a misconception.

The actual document says this:

"Thirty-nine states do not have a physician "supervision" requirement for CRNAs in nursing or medical laws or regulations. If clinical "direction" requirements are considered in addition to "supervision," 31 states do not have a physician supervision or direction requirement for CRNAs in nursing or medical laws or regulations. Taking into account state hospital licensing laws or regulations as well, 33 states still do not require physician supervision. Taking into account state hospital licensing laws or regulations, 24 states still do not require physician supervision or direction."

The states which do have some language are left intentionally grey as the expert for anesthesia services is the CRNA and not the operating physician. Case law has proven that in every case, the CRNA working independently (including in supervision states) is 100% liable for the anesthetic and surgeons do not get sued any more often with CRNA only vs MDA only practice. Surgeons carry ZERO additional liability for working with a CRNA.

So the term "supervision" becomes very negative when in reality it means nothing but signing a chart and no actual supervision or direction is required. That is the reason I leave the word out since in reality it has a different meaning that what people would take it as. The reality is this is ONLY about a billing situation.

Comments?Mmackinnon (talk) 18:34, 15 June 2009 (UTC)

 * Hello, let me start out that users who claim ownership and leave personal attack on personal pages, as you did, are rarely honest, neutral editors.

Second, the source states: "The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" (the terms are used synonymously in the November 13 rule) from the federal supervision requirement"...further "14 states as of June 2005)

Iowa opted out of the federal supervision requirement in December 2001. Nebraska opted out in February 2002. Idaho opted out in March 2002. Minnesota opted out in April 2002. New Hampshire opted out in June 2002. New Mexico opted out in November 2002. Kansas opted out in March 2003. North Dakota opted out in October 2003. Washington opted out in October 2003. Alaska opted out in October 2003. Oregon opted out in December 2003. Montana opted out in January 2004. (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.) South Dakota opted out in March 2005. Wisconsin opted out in June 2005." and: "18 states permit CRNAs to practice "independently."" This is not consistent to what is stated in this and other articles on this topic. Fuzbaby (talk) 01:21, 16 June 2009 (UTC)

 * First, I deleted a post I made out of frustration on your talk page before i actually posted it. However, your attempt at an ad hominem is noted. In anycase, you clearly do not understand the difference between CMS rules for participation in medicare and how they use the terms medical direction and supervision. CRNAs can practice independently in every state in the union this has ALWAYS been true. The CMS rules also state "supervision and medical direction are not comments or direction in relation to scope of practice or control". These are billing terms which explain WHAT and anesthesiologist must do in order to get paid for their participation in the anesthetic (if they are there). Supervision by the operating practitioner involves only them signing an ORDER for anesthesia to be delivered in order for the CRNA to collect 100% physician fee schedule for medicaid. There is no requirement otherwise for 'supervision'. So what you have edited in inaccurate since you suggest supervision as much more than a billing term and that independent practice (billing without someone signing) has anything to do with scope of practice or practice environment. This is simply not the case. Please show me where the term "and approve" is used in that document. Also please explain this statement

"Many states place restrictions on practice, and hospitals often regulate what CRNAs and other midlevel providers can or can not do based on local laws, provider training and experience, and hospital and physician preferences"

 * I do not fund this in the article either. Moreover, this is also true for every practitioner including physicians. Please show me where it states there is any requirement for "physician preference" as well. I do not find this in the article nor do i find that there is any difference in these requirements for CRNAs as there are for physician requirements. They too have to deal with state laws, hospital policy, local laws, training and experience and hospital preference. Why did you not add this also in the physician section? This seems biased. Please defend these changes. As was agreed to by the moderators previously in this discussion page this is vandalism without proper consensus or discussion.Mmackinnon (talk) 03:18, 16 June 2009 (UTC)

Proposal to split Anesthetic agents to separate article
This article is getting rather long, and to mirror other medical fields on Wikipedia, I propose that the "Anesthetic agents" section be split to its own article. Almost all drug groups have their own articles, separate from the field of medicine that uses the drugs (see Major drug groups). There used to be an article called Anaesthetic drugs, but it was moved to List of anaesthetic drugs. What I propose is merging the "Anesthetic agents" section of this article with List of anaesthetic drugs, and then moving the article to Anesthetic. Anesthesia/Anesthetic would then parallel the related articles local anesthesia/local anesthetic and general anesthesia/general anesthetic. A main link to Anesthetic with an overview summary would then be placed in the "Anesthetic agents" section of this article. --Scott Alter 18:08, 20 June 2009 (UTC)
 * Anyone have any comments? --Scott Alter 00:12, 5 July 2009 (UTC)

Since there were no objections, I completed this split. The article is currently at List of anaesthetic drugs, until an admin deletes Anesthetic so List of anaesthetic drugs can be moved there. --Scott Alter 17:23, 8 September 2009 (UTC)

NYCMD DO NOT DELETE REFERENCES
NYCMD, it is not your place to delete valid references from this article. Nor is it your place to edit the Nurse Anesthesia section because it does not fit your personal opinions. Moreover, lifelinetomodernmedicine.com is an ASA owned website and by definition biased. It isnt a reference, simply a page for ASA agenda. Mmackinnon (talk) 03:03, 11 May 2010 (UTC)

article reassessment
This article has significant problems related to MoS compliance, content (e.g., the prose is riddled with grammatical and spelling errors) and referencing (e.g., the article is nearly devoid of reliable sources). Due to these issues, I have reassessed this article as Start class. There is also a long history of NPOV issues, edit wars, vandalism, and heavy use of edit reversions. This article is greatly in need of attention from expert editors and any other interested editors. Respectfully, DiverDave (talk) 05:30, 10 September 2010 (UTC)

Horace Wells
I think Dr. Horace Wells should be mentioned in this article. He gave an unsuccessful demonstration of laughing gas with a dental patient in MGH and was booed at. But he was a pioneer of anesthesiology also. — Preceding unsigned comment added by 66.30.5.187 (talk) 23:24, 2 October 2011 (UTC)

Types of Anaesthesia
Classification has to be refined to only two broad groups such as 1)General and 2)Regional. Further Regional anesthesia is to be divided into a.Spinal anesthesia, b.Epidural anesthesia, c.Nerve Blocks, d.Bier's Block (IV Regional anesthesia), e.Field block, f.Local infiltration. Dissociative anesthesia is a type of phenomenon caused by specific drug such as ketamine to induce painlessness. It comes under the classification of Total Intravenous anesthesia (TIVA) which is a sub-group under general anaesthesia.Drvijay2000 (talk) 17:13, 22 December 2011 (UTC)

Raymond Lullus?
There is no citation for the section about Raymond Lullus first discovering ether. His wikipedia page makes no mention. Other sources -- including Cordas' wikipedia page -- say it was first synthesized by Valerius Cordas in 1570 when he mixed ethanol and sulfuric acid, calling the result "Sweet Oil of Vitriol."Msalt (talk) 21:52, 26 April 2012 (UTC)

OMFS section
The discussion of OMFS in this detail is WP:UNDUE weight. All surgical residencies, as well as many internal medicine subspecialties, are trained in administering anesthetic medications. However, this is not the place to discuss one specific surgical subspecialty, but to discuss those providers whose primary roles are to provide anesthesia related medciations (such as anesthesiologists, CRNAs, etc). I would not mind a section, appropriately sourced and weight to describe that physicians in general can be trained in administering anesthetics such as critical care physicians, etc., but the section as written was completely UNDUE and reads like an advertisement for the OMFS subspecialty. Yobol (talk) 22:25, 8 July 2012 (UTC)

Improving article
Looking to see who is active on this article. I started looking to see where people land when investigating basic medical topics and this is a popular landing page for anesthesia related topics. However, it seems largely to be a discuss/debate about the role of various professionals who provide anesthesia rather than anaesthesia itself. I'd like to rework the article following the basic Surgeries and procedures MEDMOS outline and putting the Outline of anesthesia into the narrative so people can link to the specific topic needed. Would people be opposed to this? Anyone wanting to help? Thanks. Ian Furst (talk) 18:43, 8 February 2014 (UTC)
 * I am very much in favor of your proposal, and I would be most happy to collaborate if you wish. And yes, the article should follow Surgeries and procedures MEDMOS and should be focused on the topic of anesthesia and not on who provides it. DiverDave (talk) 03:46, 9 February 2014 (UTC)

My plan is to use the following MEDMOS heading structure listed below. Sources in this article are mostly primary and need to be changed to secondary. My main resource will be Miller's Anes 2009 to start with a planned change to sources available online with time. I'll also be making a conscious effort to include as many of the Wikilinks listed in the Outline of anesthesia as possible (without making the article look link a link-farm). My first priority is to create a scope more directed to the user.

 * Indications
 * Discussion of sleep memory and consciousness

 * Contra-indications
 * I don't think I'll include this heading as there's no easy way to word the relative contraindications on all techniques for the layperson, will overexpand risk/complications to cover this

 * Technique
 * various techniques, spinal, regional, GA, sedation, etc...

 * Risks/Complications
 * summary of Ch33 from Miller's

 * Recovery or Rehabilitation
 * Post-op management nv, acute pain, cogn dysfunc and confusion and po vision loss

 * History (e.g., when it was invented)
 * as is with primary sources replaced

 * Society and culture (includes legal issues, if any)
 * providers discussion (may have WP:WEIGHT issue)

 * Special populations
 * discussion of various subspecialties, populations or technique - basically the chapter headings Ch 58-84 in Millers

 * Other animals
 * links to veterinary anes

Please jump in if you feel these ideas need to be modified. Ian Furst (talk) 13:05, 9 February 2014 (UTC)

First bits of revision
I've started changing the article. See Anesthesia to see the general tone I'm proposing. Very general with lots of links to relevant information. Looking for feedback from other editors. Thanks. Ian Furst (talk) 16:44, 9 February 2014 (UTC)

2nd bits of revision
The overall outline, headings and general themes are now created. My next step will be to copy edit, improve the language so it's geared more towards the layperson, diversify the references (so far I've relied heavily on Miller's Anesthesia) and add some graphs or tables especially in the Risks and complications section. Ian Furst (talk) 13:24, 16 February 2014 (UTC)

3rd bits of revision
I've now got the article to, what I believe is, the appropriate weight and scope for each area. I'll continue with general copy editing and adding in references. A graph for risk and complication turned out to be useless (it's misleading to compare M&M over the years due to risk stratification of patients). If anyone can see where a graphic might better add to the story please let me know and I'll try to create it. 13:55, 17 February 2014 (UTC)

B-class
Upgrading this article to B-class now. I think it follows MEDMOS for the most part, has 1/2 decent references (although I'd like to add more online stuff) and I think the scope is OK. Please leave feedback if you see areas for improvement. Ian Furst (talk) 02:30, 22 February 2014 (UTC)
 * I still haven't updated the opening section; waiting until the scope of the rest of the article is set, then will update and improve. Ian Furst (talk) 03:15, 22 February 2014 (UTC)

General comments

 * - Thank you very much for going through this for me. Most of the info comes from Miller’s Anesthesia (the “go-to” reference for anesthesia).  See discussion below and happy to discuss further, Ian Furst (talk) 15:39, 22 February 2014 (UTC)

From the lead section, paragraph 2: "Local anesthesia inhibits sensory perception within a specific location on the body, such as a tooth or the urinary bladder." Why is the urinary bladder suggested a location for local anaesthesia? Axl ¤  [Talk]  12:55, 22 February 2014 (UTC)
 * Cystoscopy, This is what happens when someone focused on the HN uses a general anaesthesia text. It’s a weird combo for wiki and I’ll change it. Ian Furst (talk) 15:39, 22 February 2014 (UTC)  ✅ Ian Furst (talk) 21:27, 22 February 2014 (UTC)

The opening sentence of "Medical uses" implies analgesia. However "analgesia" is repeated in the list of five bullet points. Axl ¤  [Talk]  13:03, 22 February 2014 (UTC)
 * I’m trying to create a framework for the layperson by stating what I think a layperson would perceive as the rationale for anaesthesia (“I don’t want it to hurt) with what the clinician needs (5 points). I’ll  have to think of a less specific way to orientate the reader in the first sentence.  I didn’t want to start off with a technical list.  Ian Furst (talk) 15:39, 22 February 2014 (UTC)

In "Medical uses", "immobility (lack of movement)" is not accurate. Immobility could perhaps be achieved with restraints (maybe like prisoner restraints?). The phrase should properly be "muscle relaxation". When the surgeon's scalpel cuts, the muscles will reflexively contract. Muscle relaxation is required to prevent this and make the surgeon's job easier. Muscle relaxation is an important part of general anaesthesia, but it hasn't been mentioned anywhere in the article. Axl ¤  [Talk]  13:11, 22 February 2014 (UTC)
 * Immobility comes straight from Miller. Generally, when anesthetists refer to muscle relaxation they’re talking about paralytics like sux/roc/whatever which aren’t always used.  For much of our head and neck stuff, they don’t give it unless the patient is “fighting” the vent.  Whereas in abd sx, they almost always have to give it to retract the abd wall.  Surgery, may require immobility but not always muscle relaxation.  I’m pretty sure this is the correct term. Ian Furst (talk) 15:39, 22 February 2014 (UTC)

From "Medical uses", paragraph 4: "More important to the patient, is the loss of any memory of the events (amnesia)." Is that really more important to the patient? Axl ¤  [Talk]  13:13, 22 February 2014 (UTC)
 * Good point, too subjective. Again, I’m trying to orientate the reader before getting into the technical jargon of hypnosis v amnesia. Will change. Ian Furst (talk) 15:39, 22 February 2014 (UTC) ✅

From "Medical uses", paragraph 4: "Inhalational anesthetics will reliably produce amnesia though general suppression of the nuclei but at doses well above those required for loss of consciousness." Is that really true? Inhalational anaesthetics will cause unconsciousness but without causing loss of memory? Axl ¤  [Talk]  13:16, 22 February 2014 (UTC)
 * No it’s not, thank you. I mis-read the paragraph as “For the volatile anesthetics, memory formation is impaired at drug concentrations between a 25% and 50%” (which is a high dose) but it was actually, “....25% and 50% of  the minimum alveolar concentration (MAC)”   This is a long section in Miller on memory formation (and how BZD’s differ from volatile agents) and consciousness during anesthesia.  I’ll reword it. Ian Furst (talk) 15:39, 22 February 2014 (UTC) ✅

In the "Medical uses" section, I am not convinced that amnesia is an important part of anaesthesia. Amnesia is listed first in the bullet points, and a paragraph about it comes before unconsciousness. Certainly amnesia is a useful side-effect in certain unpleasant wakeful procedures such as endoscopy, but is this really a part of anaesthesia? Axl ¤  [Talk]  13:25, 22 February 2014 (UTC)
 * I’ve listed them in the same order as Miller.  Sleep, memory and consciousness are major aspects of anesthetic physiology but tightly related and evolving research fields (see next question below for more on this).  Awareness under GA (which may actually have more to do with consciousness than memory, but that’s splitting hairs) is a significant concern.  Again, Miller lists it implicitly (first) as one of the endpoints of anesthesia.  From everything I read and from the perspective of patients many of whom say their main goal is that they don’t want to remember anything, I think it’s important and a major part of anesthesia imo. Ian Furst (talk) 15:39, 22 February 2014 (UTC)
 * "many of whom say their main goal is that they don’t want to remember anything." Even if they say that, is that really what they mean? If anaesthesia involved strapping people down and causing extreme pain without analgesia, but with subsequent amnesia, would that be acceptable? Axl  ¤  [Talk]  22:27, 22 February 2014 (UTC)
 * Not at all. By the same logic would anesthesia with immobility, analgesia, hemodynamic stability and muscle relaxation be acceptable if the patients' have recollection of the events? I've emailed the author of the chapter to ask for more info on the distinction between hypnosis, amnesia and lack of consciousness. Hopefully his input will make it easier to draw the distinctions. I assume we can both agree that a lack of awareness is an end point of general anesthesia.  From your responses, am I to understand that you believe a hypnotic state includes amnesia and a lack of consciousness?Ian Furst (talk) 22:43, 22 February 2014 (UTC)
 * "By the same logic would anesthesia with immobility, analgesia, hemodynamic stability and muscle relaxation be acceptable if the patients' have recollection of the events?" Definitely yes. Consider every form of local and regional anaesthesia. Axl  ¤  [Talk]  22:58, 22 February 2014 (UTC)
 * "am I to understand that you believe a hypnotic state includes amnesia and a lack of consciousness?" No. Amnesia is the loss of memory. If there was no perception of the event (such as a stimulus) to begin with, there can be no memory of it to be lost, therefore amnesia is irrelevant. During hypnosis (anaesthetic hypnosis), perceptions are not achieved, therefore amnesia is irrelevant. In the context of anaesthesia, amnesia is only relevant for wakeful procedures (local/regional anaesthesia).

 * My understanding of unconsciousness (in the medical sense) is that it requires lack of perception of all stimuli. From reading your definition of hypnosis: "Hypnosis is defined as a lack of perceptive awareness to non-noxious stimuli", I think that unconsciousness also requires the lack of perception of noxious stimuli—i.e. analgesia. Hypnosis does not inherently include analgesia, which is why analgesia is required alongside hypnosis. Anaesthetic unconsciousness could be regarded as the combination of hypnosis with analgesia. Axl  ¤  [Talk]  00:01, 23 February 2014 (UTC)

I checked 2 other e-books and can't find the endpoints listed. I found this article that lists them as hypnosis, analgesia, amnesia and reflex suppression (it's a study using fMRI so maybe the didn't use muscle relaxation as an endpoint?). I'll keep looking. Imo, the endpoints should all be met for a full GA and at least one of them met for other types of anesthesia. E.g. LA hit analgesia alone. What do you think the end points should be (and can you give me a reference for them)? Agree that hypnosis and analgesia need to go together. But what is awareness under GA?. What is dreaming under GA? Ian Furst (talk) 13:44, 23 February 2014 (UTC)
 * So far, I have not looked in any sources. (I was kinda hoping that you would quote the definitions and correct my mistakes.) But I am happy to look in some sources. I shall see what I can find. Axl  ¤  [Talk]  01:02, 24 February 2014 (UTC)
 * Can you give me a page number/chapter for Miller's Anesthesia please? Axl  ¤  [Talk]  16:48, 24 February 2014 (UTC)

Is anaesthetic hypnosis truly different from unconsciousness? Axl ¤  [Talk]  13:26, 22 February 2014 (UTC)
 * That is an extremely tough question for me to answer. In my mind, sleep, hypnosis and consciousness (as they related to anesthesia) are all tightly related with large overlap. Hypnosis is defined as a lack of perceptive awareness to non-noxious stimuli.  Consciousness is the capacity for neural systems to synthesize information (the ability to generate a unified perception from various sensory inputs).  I’m not sure a hypnotic state is synonymous with a lack of consciousness to noxious stimuli (which is a desired result of anesthesia).  Consciousness is a newer research field in anesthesia. I could try and track down of the authors of the chapter in Miller and ask.  Which part of the article triggered the question? Ian Furst (talk) 15:39, 22 February 2014 (UTC)
 * "lack of consciousness to noxious stimuli." Using your previous definition of "consciousness", that statement is meaningless. Perhaps you meant "lack of perception of noxious stimuli"? Otherwise known as "analgesia". Axl  ¤  [Talk]  22:47, 22 February 2014 (UTC)

Another general comment about the "Medical uses" section: when I was a student, I learnt that anaesthesia focussed on three aspects—analgesia, hypnosis and muscle relaxation. While that view may be a little simplistic, it would be a good rule to focus on those three features in this Wikipedia article. Axl ¤  [Talk]  13:29, 22 February 2014 (UTC)
 * I can change the focus. Keep in mind, historically, death from shock secondary to uncontrolled automatic responses during surgery was a major issue before Harvey Cushings work. Even if it’s not evident to the patient, it’s still a major issue.  As already discussed, I need to get more info on hypnosis v amnesia. Ian Furst (talk) 15:39, 22 February 2014 (UTC)

Hypnosis, unconsciousness and amnesia
From one of the authors of Millers who coauthored the relevant chapter, Thanks for contacting me. I'm happy to help clarify. In anesthesiology, when we discuss the term "hypnosis" it is used to describe the loss of consciousness endpoint. While there are many uses of term hypnosis, especially in psychology, we mean to imply the drug-induced state that causes a loss of consciousness. The presence or absence of memory (amnesia) can be completely dissociated from the loss of consciousness. However, you are correct that the loss of consciousness necessarily induces a loss of memory. I agree with the notion that anesthesia at its core can be distilled into hypnosis, analgesia, and muscle relaxation. However, there are some who would disagree with me and say that true core of anesthesia is merely amnesia, muscle relaxation, and analgesia and does not require unconsciousness. Rarely, in the setting of trauma that is life-threatening, anesthesiologists will induce a state that is merely amnesia and muscle relaxation. Once again, let me stress that this is only done during conditions when the adverse side effects of using a drug that would cause hypnosis (ie: further low blood pressure) might lead to death. Ian Furst (talk) 22:03, 23 February 2014 (UTC)

 * Thank you for posting his response (and thanks to him for replying). It is interesting to see that he equates hypnosis with loss of consciousness. This definition of hypnosis seems to be slightly different to the one that you quoted above. Consider this: can a noxious stimulus (i.e. pain) be perceived by a person in hypnosis?
 * Follow-up email (just got a response) asked him about the differing definitions of hypnosis. Specifically if the one from the book (and that I used) would still apply.  His response, "Yes, I wrote the "lack of perceptive awareness to non-noxious stimuli" simply to imply that the presence/absence of consciousness must be done in the absence of painful stimuli." Presumably, the presence of noxious stimuli will change the threshold for consciousness? Ian Furst (talk) 01:13, 24 February 2014 (UTC)

 * He also describes the absence of memory as amnesia. If a person has never experienced an event, he has no memory of that event. However that absence of memory is not amnesia. With respect to the author, the definition should be loss of memory, not absence of memory. Axl  ¤  [Talk]  00:30, 24 February 2014 (UTC)
 * It may depend on the drugs being used. I believe inhalation anesthetics globally suppress nuclei so memories are not formed (and at 25-50% of MAC, doses unlikely to cause hypnosis).  In this case, there may not be hypnosis but there will be amnesia and, I don't think the memories ever formed.  Benzodiazapines, on the other hand, will block the transition from short-term to long-term memories.  So they're lost.  I can give midazolam, fentanyl and LA (a common sedation), complete a procedure with the patient quite conscious but they have no memory or the event.  The same with ketamine and local.  Which end points did I hit?  Analgesia for sure.  But what else?  Based on the new definition of hypnosis, I have not achieved it.  Ian Furst (talk) 01:13, 24 February 2014 (UTC)
 * Maybe the way to frame it is that hypnosis will include amnesia but amnesia may not be associated with hypnosis. Ian Furst (talk) 01:15, 24 February 2014 (UTC)

reworked and shortened the first paragraph and 3 endpoints for your review. Ian Furst (talk) 17:51, 24 February 2014 (UTC)
 * I have access to a copy of Miller's Anesthesia now. I reluctantly accept that the text places amnesia in a prominent position—perhaps even more so than hypnosis, analgesia or muscle relaxation. I need to do some more reading, but I have not forgotten about this article. Axl  ¤  [Talk]  01:11, 28 February 2014 (UTC)
 * no rush. This article is a marathon for me, not a sprint. Ian Furst (talk) 02:53, 28 February 2014 (UTC)

At the beginning of the section, I have explained that hypnosis has a specialized meaning in pharmacology and anesthesiology, different from its more familiar meaning in psychology and literature. I also changed three uses of the word "affect" to "effect", because I think the latter corresponds with the intended meaning. To affect means to influence, whereas to effect means to cause or bring about.CharlesHBennett (talk) 07:15, 20 August 2015 (UTC)

Article claims fight or flight response leads to shock
The current version of the article claims that the fight or flight response leads to circulatory shock. This seems counter-intuitive, since the fight or flight response increases blood pressure, while circulatory shock is a result of low blood pressure. This statement needs to have a reliable reference, and probably also an explanation to justify how the fight or flight response results in shock.

I think it would make sense if it were clarified to refer to only cases of excessive fight or flight response, causing extreme sinus tachycardia, resulting in decreased stroke volume leading to reduced cardiac output. However, the way it's written right now, it sounds like the article is claiming that people have a dangerous drop in blood pressure whenever they are exposed to an alarming or stressful situation, but that's the opposite of what usually happens. -NorsemanII (talk) 00:10, 4 May 2014 (UTC)
 * Good point, let me look for the specific reference. I don't think the reference is to shock during the procedure but that which results days later due to tissue damage.  My understanding (and I will look for the specific mechanism) is that extremes of blood pressure, pulse and vascular shunting lead to local vasoconstriction, thrombosis, regional malperfusion, release of superoxide radicals, and direct cellular damage which, in turn, leads to cellular injury, organ dysfunction and death.  Harvey Cushings observations, where that morbidity (with hernia operations) was decrease in the post-op period, not the perioperative period.  Let me find details and will repost. Ian Furst (talk) 12:55, 4 May 2014 (UTC)
 * Here is the reference Shock is the correct term.  We could change the flight or flight response to extremes of blood pressure but I think it's less understandable for the layperson.  Thoughts? Ian Furst (talk) 13:17, 4 May 2014 (UTC)
 * The reference (Miller's Anesthesia, 7th edition, pages 29–30) does not mention the "fight-or-flight response". It is reasonable to equate "stress response" with "fight-or-flight response", but this is only mentioned in the last paragraph where the significance of catecholamine release is described. I do not think that it reasonable to equate "stress" with "fight-or-flight response". "Stress" is a rather more generic term.

 * "Shock" is mentioned only once: "Accurate anesthetic records were maintained during Cushing's cases and confirmed his opinion that shock could be prevented by careful attention to avoiding the stresses associated with surgery." I certainly do not think that "stresses" is used here to mean only "fight-or-flight response". Nor am I convinced that Harvey Cushing's definition of the word "shock" in the early 20th century is synonymous with the modern definition of "circulatory shock". Axl  ¤  [Talk]  14:46, 4 May 2014 (UTC)
 * I think the point that needs to be made is that blunting of autonomic reflexes (e.g. extremes of blood pressure and pulse that can occur with surgery) lowers post-op morbidity, and is an important part of modern anesthesia. I think it's helpful to link to fight or flight response so people can understand why the body responds with increase heart rate/BP during surgery.  I'm relatively indifferent as to whether we tie the cause of the increased post-op morbidity to shock or not. Let me read some more or email the author.  Ian Furst (talk) 15:27, 4 May 2014 (UTC)

, like everything else with this article the answer doesn't seem to be so clear cut. There is evidence that blunting the response prevent perioperative MI's. Second, it decreases levels of catabolic hormones which are thought to prolong recovery (nothing about morbidity). Here are two quotes, "Studies have demonstrated that perioperative β-adrenergic blockade reduces the risk for perioperative myocardial infarction in patients at risk for this complication." "It was learned that during major surgery, patients anesthetized with traditional vapor anesthetics, with or without opioids, displayed increased levels of catabolic hormones postoperatively" ... "Various methods of preventing postoperative catabolism have been under investigation for several years. The resulting catabolic state is thought by some to delay recovery.." Let me keep looking to see if it's tied to shock. BTW, currently the article is titled Shock (circulatory) but it describes all types of shock. Maybe we should rename to Shock (physiologic) Ian Furst (talk) 22:46, 4 May 2014 (UTC)
 * I think I found the relavent section on it. It relates to the catabolic hormones which they believe increases mortality but no-one is sure why.  Here is the relavent text, "Anesthetic techniques or drugs that minimize the stress response may reduce morbidity and mortality in a variety of circumstances." and "Many different hormonal changes induced by surgery have been described. However, the concomitant  neural, cellular, immune, and biochemical changes have been less well defined, and little is understood or proven with regard to how modifying hormonal responses alters outcome.213 Additional studies are necessary for complete elucidation of the relationship between control of surgically induced hormonal responses and outcome."  Ian Furst (talk) 22:54, 4 May 2014 (UTC)
 * proposed change in the lead to, "...to surgical stimulation leading to a heart attack and production of catabolic hormones. Ian Furst (talk) 23:02, 4 May 2014 (UTC)

 * None of the quotations that you use here describe "shock".

 * "BTW, currently the article is titled Shock (circulatory) but it describes all types of shock." Exactly how are you defining "shock"? Axl  ¤  [Talk]  23:03, 4 May 2014 (UTC)
 * I have not described "shock" in any of the quotes, because I think it should be removed from the lead. Based on my reading, I believe the physiologic state created by the extremes of BP/pulse are similiar to shock (or in the case of periop MI, caused by cardiogenic shock secondarily) but I can't find anything that links to two.  Therefore, I think it should be removed and replaced with a more percise description of what is believed to be occuring.
 * The definition of shock that I found useful is, "a multifactorial syndrome resulting in inadequate tissue perfusion and cellular oxygenation affecting multiple organ systems." the point being that even if hypoperfusion and tissue ischemia are the triggers for shock, there are only a small part of the physiologic cascade that results. Ian Furst (talk) 23:13, 4 May 2014 (UTC)
 * I see that the definition you are using describes "inadequate tissue perfusion". In what way is the definition different from "circulatory shock"? Axl  ¤  [Talk]  23:21, 4 May 2014 (UTC)
 * I'm not sure what you're referring to. Are you talking about whether the definition should be included in the lead of this article or whether the title Shock (circulatory) might be changed? With respect to the latter, I think the title leads one to think of hypovolemic or hemorragic shock rather than the shock state.  Even though the definition includes tissue perfusion, the more complete explaination from the pathophys section better describes it, "Whereas hypoperfusion and cellular  ischemia were previously thought to be sufficient to cause shock, they are now recognized as being solely the initiating triggers for a complex physiologic cascade. Cellular hypoxia predisposes tissues to "reperfusion injury" leading to local vasoconstriction, thrombosis, regional malperfusion, release of superoxide radicals, and direct cellular damage. Subsequent activation of neutrophils and release of proinflammatory cytokines such as tumor necrosis factor (TNF), interleukin-1 (IL-1), and platelet activating factor result in cellular injury, organ dysfunction and failure, and frequently death." Ian Furst (talk) 23:58, 4 May 2014 (UTC)
 * "I think the title leads one to think of hypovolemic or hemorragic shock rather than the shock state." With respect, that interpretation is incorrect. Here are just a few sources that mention circulatory shock—where it is not restricted to hypovolaemic shock:, , . Tintinalli's Emergency Medicine defines shock: "Shock is circulatory insufficiency that creates an imbalance between tissue oxygen supply (delivery) and oxygen demand (consumption)." Shock is implicitly circulatory, which is why "circulatory" is often dropped from the phrase. Axl  ¤  [Talk]  00:41, 5 May 2014 (UTC)
 * You'll notice I didn't say that circulatory shock is restricted to hypovolemic shock only that, in my opinion, I believe that the title leads one to think of shock as a disorder of circulation alone. From your sources, "Importantly, although the focus of this review is circulatory shock, it must be appreciated that inflammatory mediators and oxidative stress from circulatory shock and reperfusion or due to other factors (for example, sepsis) can also directly cause tissue injury." Regardless, my opinion is that the article would be better titled Shock (physiologic) which would take into account the complexity of the disorder but I acknowledge that the term circulatory shock is also used and the title works. Just a suggestion.  Ian Furst (talk) 01:24, 5 May 2014 (UTC)

 * "I believe that the title leads one to think of shock as a disorder of circulation alone." No doubt you will be writing to the New England Journal, etc., to inform them of this potential confusion.

 * In Wikipedia, we have to reflect the sources. The medical literature most commonly uses the unqualified word "shock". However "Shock" has many other meanings. The second most common term used in the medical literature is "circulatory shock". PubMed has 2,140 entries for "circulatory shock". There are only five entries for "physiologic shock" and eight entries for "physiological shock".

 * Hence Wikipedia's title "Shock (circulatory)" is appropriate—more so than "Shock (physiologic)". Axl  ¤  [Talk]  09:52, 7 May 2014 (UTC)

Got it Ian Furst (talk) 11:39, 7 May 2014 (UTC)

 * Your proposed test is: "A general anesthetic will cause a person to sleep but the body can still mount a fight-or-flight (stress) response to surgical stimulation leading to a heart attack and catabolic hormones."? While this is supported by the reference, I don't see why this should be in the lead section. Axl  ¤  [Talk]  18:07, 11 May 2014 (UTC)
 * I'm not opposed to it being removed. Ian Furst (talk) 19:20, 11 May 2014 (UTC)
 * Okay, thanks. I have deleted the sentence from the lead section. Harvey Cushing's finding is described in the "General Anesthesia" section, which is fine. Axl  ¤  [Talk]  20:46, 11 May 2014 (UTC)
 * Should we also remove the sentence abou the muscles contracting making surgery impossible? I don't think the paragraph flows well with it there. Ian Furst (talk) 21:01, 11 May 2014 (UTC)

anesthesia is "unique" in that it provides no "particular benefit"
really have a problem with this statement- what about keeping you alive while the "actual benefit" is being performed? or not recalling the assault? or perhaps emerging pain-free? shall i continue? and this is for a "standard" anesthetic not to mention the myriad other "non-beneficial" aspects of anesthesia — Preceding unsigned comment added by 69.201.149.239 (talk) 02:32, 29 March 2015 (UTC)
 * Agreed, I would suspect most surgery patients would describe not screaming in pain a very good "benefit". I removed that clause. Yobol (talk) 02:42, 29 March 2015 (UTC)

chloroform or ether
this article suggests that chloroform use replaced ether, but the wiki article on ether says that ether "supplanted" chloroform. this appears to be a contradiction.... and i wonder what the resolution would be. -- chris — Preceding unsigned comment added by 108.34.62.49 (talk) 10:45, 17 October 2015 (UTC)

Lead section
In the UK, "Anaesthesia" is also the name of the medical specialty known elsewhere as "Anesthesiology". I wonder if this is worth mentioning? Axl ¤  [Talk]  23:46, 19 March 2014 (UTC)
 * I can add the info under the society section. We call them the same in Canada.  The article was previously a hodge-podge of debate about who gives anesthetics so, if you're OK with it, I'd prefer to keep discussion of such issues like this isolated to that section.  Ian Furst (talk) 03:27, 20 March 2014 (UTC)
 * Hmm, okay. I edited the disambiguation page to add "Anesthesiology". However I have just discovered that "Anesthesiology" redirects to this article! I shall create a stub article for "Anesthesiology". Axl  ¤  [Talk]  12:53, 20 March 2014 (UTC)
 * Didn't know about the redirect - thanks. Not surprised though - the article was previously a mix about anesethesia itself and the specialties. Ian Furst (talk) 13:13, 20 March 2014 (UTC)

Spelling
I believe Anesthesia is the only spelling, correct? Or am I mistaken?ThisGuyIsGreat (talk) 21:41, 27 July 2015 (UTC)

Anaesthesia is the usual spelling in British English, anesthesia in American English.CharlesHBennett (talk) 07:22, 20 August 2015 (UTC)

Removed information about professional field from lead
The intro to the article contained information about the difference between British versus American naming of the term. I removed this, and changed the lead a little to avoid drawing attention one way or the other to the name of the professional discipline.

This information is already present in the "society and culture" section with references, so when I removed the information from the intro, I did not paste it elsewhere because it already was included.

I removed this because I did not think that the UK/US variation was so urgent to describe in the lead. It is enough to list the two spelling variations, anesthesia or anaesthesia, and leave further discussion to the society section in the body of the article.  Blue Rasberry  (talk)  19:50, 27 July 2016 (UTC)

External links modified
Hello fellow Wikipedians,

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Missing information about Hanaoka Seishū
Hanaoka Seishū was the first surgeon to perform operations under general anesthetic (40 years before Crawford W. Long), yet he isn't even mentioned in the article. Kaldari (talk) 04:17, 31 December 2016 (UTC)

Recollection of operation under a hypnosis.
An anesthesiologist now dead (Alan Dobkin) told me that although unconcious during the procedure, some patients can recall under hypnosis aspects of the procedure, including conversations in the operating room. I am not a doctor and have no way of knowing the truth of this (my father, also dead, was an anesthesiologist), but if it is true, I'm surprised not to see it mentioned. I don't believe he was talking about awareness during anesthesia. deisenbe (talk) 13:37, 19 September 2017 (UTC)

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Help me!
Can you help me move all the pages in Category:Anesthesia to use the American form. I already did some. The reasons why I am doing this is because firstly, the American spelling is used on the article title on this page. I never moved this page at all, and secondly, all the articles in the category should have consistent titles with each other. I appreciate any help from any editor(s) available. Thank you. Interstellarity (talk) 22:35, 29 April 2019 (UTC)

 * That seems inappropriate without a prior discussion. I see no reason why the title of this article should predetermine the title of all others when there's a BE/AE spelling difference. See MOS:RETAIN: "An article should not be edited or renamed simply to switch from one variety of English to another." Huon (talk) 23:58, 29 April 2019 (UTC)

RFC
I would like to discuss whether it whether the titles in the should be consistent with one another. I moved some of the pages, but I was told to discuss this prior to doing that. Any thoughts on this? Interstellarity (talk) 00:19, 30 April 2019 (UTC)
 * I see three basic options:
 * Move everything to "Anesthesia" and the like.
 * Move everything to "Anaesthesia" and the like.
 * Do nothing and leave all articles as-is (reverting the moves that have already been done).
 * This discussion should probably be linked to on the talk pages of all relevant articles (with both "anesthesia" and "anaesthesia" spelling), on Category talk:Anesthesia, and at WT:WikiProject Medicine. Personally I see no strong reason for either option 1 or option 2 and would thus default to option 3. Huon (talk) 07:30, 30 April 2019 (UTC)
 * Comment Blanket change seems inappropriate... from MOS:ENGVAR: "The English Wikipedia prefers no national variety of the language over any other." In the absence of policy arguments or sources supporting the change, MOS:RETAIN seems to apply. Little pob (talk) 10:43, 30 April 2019 (UTC)
 * agree w/ Little Pob--Ozzie10aaaa (talk) 11:40, 1 May 2019 (UTC)
 * I think it's a close case, and honestly, I feel quite torn as an editorial matter between the options. I will say that WP:ENGVAR isn't so much relevant (there's no real ENGVAR question here insofar as no one appears to be contending that these changes be made to conform to a dialectic preference, and the ENGVAR language is very narrow and clearly doesn't rule out that other stylistic/formatting/organizational/other editorial concerns can provide a basis for a change--said language is concerned with such changes being made purely because a given editor has an idiosyncratic/quasi-nationalistic preference for one variant over the other as the "proper" spelling. ENGVAR comes to quash that kind of petty edit warring, but not to rule out spelling changes for other purposes, wholesale and as against every other style or policy convention. MOS:RETAIN is also ambivalent as to this point: "When an English variety's consistent usage has been established in an article, maintain it in the absence of consensus to the contrary ."(emphasis added) clearly anticipates that there are occasions when the established usage normally promoted under ENGVAR might be found undesirable for whatever reason. And again, at the end of that subsection of the policy: "An article should not be edited or renamed simply to switch from one variety of English to another." (emphasis again added), meaning only changes made expressly for the purpose of promoting one spelling variant or another, without another (sufficiently more worthwhile) justification are to be uniformly avoided. And then there's the fact that both ENGVAR and RETAIN are manual of style guidance, which must yield to compelling content WP:policy arguments in almost all cases.

 * So, for example, the titles of individual articles definitely can be changed if there is a sufficiently strong and accepted argument that the collective corpus of WP:RS (or in this case WP:MEDRS) overwhelmingly prefer one spelling over another; that is not just "simply" a change for the sake of preferring one dialect over another, as ENGVAR and RETAIN require for the change to be proscribed/avoided--and even if it were, WP:COMMONNAME and WP:WEIGHT would control over them. So really the issue comes down to a more pragmatic test, because it turns out we have some discretion here to decide what as an editorial matter is best for the article article (or articles, as the case may be here. And in pragmatic terms I see two prevailing contrary arguments: 1) creating uniformity might be of some minimal use for those navigating our articles (it would be pretty minor though), and 2) There may be some isolated cases where there is an ENGVAR and COMMONNAME preference for a given article that runs counter to the chosen spelling for articles generally (I doubt that's the case here, but it's a technical possibility) and besides, policy prefers leaving things well enough alone if a sufficiently good reason hasn't been provided to overhaul the situation (basically, an application of the KISS principle).  I guess if I had a gun to my head, I'd have to say the second set of arguments seems like an ever-so-slightly more compelling rationale, but honestly, this is a six one/half dozen the other kind of situation for me--I don't think any approach contemplated above really breaks anything. Snow let's rap 06:15, 1 May 2019 (UTC)
 * I contributed a lot to this particular article, and use anaesthesia in my own life, but left it as is. My rationale was that most of the references used anesthesia, and didn't see the need to change, for changes, sake.  Wrt popularity, Google trends rates anesthesia a roughly 4x more popular term than anaesthesia worldwide.  If the decision to harmonize is made, I'd vote for anesthesia but don't see the need to do it as long as redirects are in place. Would we have the same discussion with health care and healthcare? Ian Furst (talk) 12:10, 1 May 2019 (UTC)
 * I'd also add that I think using both versions is more inclusive. As a Canadian speller, it's nice to see our version of it on Wikipedia (anaesthesia).  Ian Furst (talk) 12:30, 1 May 2019 (UTC)

 * Comment: If you feel you must enforce consistency one way or another and you are willing to drum up support for a crusade, have fun; I won't be involved in it, MOS:ENGVAR or no MOS:ENGVAR, but do please insist on ensuring that there are redirections that will painlessly present the correct articles to any user, no matter which spelling he happens to have used in the search. Remember, apart from the text and titles etc, there are plenty of refs and quotes that will not consult your personal tastes, and for you to meddle with their spelling is definitely a no-no. JonRichfield (talk) 12:51, 1 May 2019 (UTC)

 * Leave articles as they are. I don't think that consistency between differently titled articles is an adequate reason to rename. Axl ¤ [Talk] 10:36, 2 May 2019 (UTC)
 * Question Does this call for an early closure? It seems the consensus is to keep the status quo and not worry about changing titles. Interstellarity (talk) 19:08, 2 May 2019 (UTC)
 * I'd vote yes to early closure. There's been no support for the change. Ian Furst (talk) 20:02, 2 May 2019 (UTC)
 * Agree with Ian Furst. If Interstellarity is OK with an early closure, why keep it open? Huon (talk) 20:08, 2 May 2019 (UTC)

 * Agree with closure JonRichfield (talk) 07:24, 5 May 2019 (UTC)

Wiki Education assignment: Human Anatomy Lab
— Assignment last updated by Chris SS BE (talk) 06:29, 11 March 2024 (UTC)

title: Talk:Anesthesia


text:
Regions of Kyrgyzstan

Kyrgyzstan is divided into seven regions (облус; область). The capital, Bishkek, is administered as an independent city of republican significance, as well as being the capital of Chüy Region. Osh also has independent city status since 2003.

The regions, with their areas, census populations and capitals, are as follows:

Each region is further divided into districts (rayon), administered by government-appointed officials. Rural communities (ayyl aymagy) consisting of up to twenty small settlements have their own elected mayors and councils.

title: Regions of Kyrgyzstan


text:
James Hannigan

James Hannigan (born 23 July 1971) is a BAFTA Award winning composer and producer. His credits include entries in the Harry Potter, Command & Conquer, Dead Space, RuneScape, Evil Genius, EA Sports and Theme Park video game series, among numerous others. He has also scored full-cast adaptations of Neil Gaiman's The Sandman (DC Comics/Audible), the Audie Award winning Alien dramas (2016–2019), BBC Radio 4's adaptations of Neil Gaiman’s Good Omens and Neverwhere.

The composer is known for themes such as the parodic Red Alert 3 Theme - Soviet March. In 2022, James Hannigan composed a new orchestral theme for the Discworld universe. Hannigan's music is regularly used in television shows and has been heard in productions including BBC America's Primeval, BBC's Top Gear, Amazon's The Grand Tour, Disney's The World According to Jeff Goldblum and many other productions.

Awards
Hannigan's music scores have been nominated five times by the British Academy of Film and Television Arts (BAFTA) and Hannigan won a BAFTA Award with Electronic Arts in 2000 for Sim Theme Park (UK title: Theme Park World). In 2010 his score for the Harry Potter and the Half-Blood Prince video game received a BAFTA nomination and won an International Film Music Critics Association (IFMCA) award. In 2014, Hannigan was nominated for a Develop Award for his work on RuneScape. His other BAFTA-nominated scores include those of Republic: The Revolution, FA Premier League Manager and Evil Genius. In 2022, The Sandman Act II received a Webby People's Choice Award for Music and Sound Design.

Live recording
Hannigan has worked with the Philharmonia Orchestra, The Skywalker Symphony Orchestra, The Slovak Symphony Orchestra, The Budapest Film Orchestra, and The Chamber Orchestra of London, recording at Abbey Road Studios, AIR Studios and Skywalker Ranch. The composer is known to be an analogue synthesizer enthusiast.

The Sandman (Audible Originals/DC Comics)
On July 15, 2020, Audible released an adaptation of the comic book series as a multi-part audio drama directed by Dirk Maggs with music by James Hannigan. The voice cast included Gaiman as the Narrator, James McAvoy as Dream, Kat Dennings as Death, Taron Egerton as John Constantine, Michael Sheen as Lucifer, Riz Ahmed as the Corinthian, Andy Serkis as Matthew the Raven, Samantha Morton as Urania Blackwell, Bebe Neuwirth as The Siamese Cat, Arthur Darvill as William Shakespeare, and Justin Vivian Bond as Desire. The production spent two months at #1 in The New York Times Best Seller list

The follow-up, The Sandman: Act II, was released on 22 September 2021, and featured most of the original cast. New additions to the cast included: Regé-Jean Page as Orpheus, Jeffrey Wright as Destiny, Brian Cox as Augustus, Emma Corrin as Thessaly, John Lithgow as Joshua Norton, David Tennant as Loki, Bill Nighy as Odin, Kristen Schaal as Delirium, Kevin Smith as Merv Pumpkinhead, and Niamh Walsh as Nuala. Neuwirth also returned, but portrayed Bast.

Interactive music
In the early years of his career in the 1990s, Hannigan worked as composer for Electronic Arts Europe before basing his studio at Pinewood Studios in England for ten years between 1997 and 2007, where he sometimes worked as a sound designer on films alongside composing. His sound design credits include New Line Cinema's Lost in Space, which was nominated for a Golden Reel Award.

One of Hannigan's best-known themes is Red Alert 3 Theme: Soviet March.

Some of Hannigan's early game credits include Space Hulk: Vengeance of the Blood Angels, Flight of the Amazon Queen, Warhammer: Shadow of the Horned Rat, Command and Conquer: Red Alert 3, Theme Park World, Sim Theme Park, Conquest: Frontier Wars, Freelancer, Privateer 2: The Darkening, Evil Genius, Grand Prix 4, and various EA Sports games in the F1 and FIFA series. His later game credits include Art Academy, Cloudy With a Chance of Meatballs, The Lord of the Rings: Aragorn's Quest, Runescape, Command and Conquer 4, Harry Potter and the Order of the Phoenix, Harry Potter and the Half-Blood Prince, Harry Potter and the Deathly Hallows, Dead Space 3 and Call of Antia.

In 2018, James Hannigan and Jagex released an orchestral album of Runescape music featuring orchestral renditions on earlier Runescape tunes along with new music by Hannigan, entitled Runescape: The Orchestral Collection. The album was recorded at Abbey Road Studio 1 in London with the Philharmonia Orchestra.

Some of his music for Nintendo's Art Academy, such as "Swan Lesson," has subsequently been heard in the Super Smash Bros. game series.

Hannigan has posted videos on the subject of his early interactive music system design for titles such as Republic: The Revolution (designed by Google DeepMind founder Demis Hassabis) on YouTube.

In 2015, he contributed music for Terraria: Otherworld, which was subsequently cancelled. A soundtrack was later released and some of the music has been used in the main Terraria game. After a period away from games, Hannigan returned to the industry to score Steelrising and Evil Genius 2 in 2021.

Screen Music Connect and other conferences
In 2013, James Hannigan founded popular yearly conference Game Music Connect with friend and industry commentator, John Broomhall. Held each year at London’s Southbank Centre, the event partnered with PRS For Music, Playstation and British Academy of Film and Television Arts (BAFTA). Running for three years between 2013 and 2015, events featured numerous panels with leading composers, and keynote speeches from industry executives from Electronic Arts, Sony Interactive Entertainment and others.

In 2018, it was announced that James Hannigan had founded a new London-based conference on film, television, game and virtual reality music, to be known as 'Screen Music Connect'.

The composer has talked at numerous conferences and events, including NY Comic Con alongside Neil Gaiman, Kat Dennings and James McAvoy, Musicworks and The BAFTA Interactive Festival. In 2012 James Hannigan was made the subject of BAFTA's Conversations With Composers, held at the Albert Hall.

Written publications
In 2004, Hannigan wrote "Changing Our Tune", a cover article for the UK's Develop magazine, outlining some of the differences between scoring for games and conventional linear media forms such as film and television. It was the magazine's first audio related cover feature.

In 2010, Hannigan was interviewed for Tom Hoover’s book, “Soundtrack Nation: Interviews with Today's Top Professionals in Film, Videogame, and Television Scoring”.

In 2015, he wrote a series of articles on video game music for Classic FM.

In 2016, Hannigan wrote a foreword for Tim Summer's book, Understanding Video Game Music, published by Cambridge University Press.

The composer started a blog in 2024 and has written on the subject of AI Music and its implications in an article entitled "AI's Hollow Harmony: Technology’s Ever-Evolving Dance with Human Creativity". He has also written on his love of retro technology and the arcades of the 1980s, showcasing his studio arcade.

Public performances
In 2007, a collage of Hannigan's music entitled Welcome to Hogwarts was added to Video Games Live debuting in London at the Royal Festival Hall on 22 October 2007, and featuring the Philharmonia orchestra.

James Hannigan's music from The Sandman has been used for several installations and launch events, including the Dream Portal at New York Comic Con, 2022.

Hannigan's 'Soviet March' theme from Command and Conquer: Red Alert 3 was performed at 'A Night in Fantasia', by the Eminence Symphony Orchestra at the Sydney Entertainment Centre, Australia on 26 September 2009. The popular track can be heard on YouTube. Other public performances include Video Games Music Live and the Games & Symphonies concert series.

On 28 October 2010, a concert of Hannigan's music was held at St. Mary's Church, Nottingham, England. As part of the GameCity 2010 Festival, the concert featured The Pinewood Singers and soloists performing the theme of 'Harry Potter and the Deathly Hallows – Part 1', pieces from Command and Conquer: Red Alert 3, Evil Genius and other titles

On 29 June 2012, Hannigan was interviewed in front of a live audience at the Royal Albert Hall's Elgar Room by presenter Tommy Pearson, as part of the BAFTA Sponsored event 'Conversations With Composers'. The event featured an overview of the composer's work and a live performances of Red Alert 3 Theme - Soviet March.

In May 2018, it was announced that there would be a performance of Hannigan's RuneScape music by the Royal Philharmonic Concert Orchestra at RuneFest 2018.

James Hannigan's music for RuneScape was performed in 2024 by the Metropole Orkest in the Netherlands as part of the Games in Concert series.

Partial list of credited works

 * Steelrising (Spiders Studio/NACON)
 * Discworld (by Terry Pratchett; Penguin Random House)
 * The Sandman (Acts ii and iii, By Neil Gaiman; DC Comics/Audible/Amazon; Webby People's Voice Award, Best Score and Sound Design)
 * The Sandman (Act i, By Neil Gaiman; DC Comics/Audible/Amazon)
 * Evil Genius 2 (Rebellion Developments)
 * Call of Antia (FunPlus)
 * Alien III (By William Gibson; Audible)
 * RuneScape: The Orchestral Collection
 * Super Smash Bros. Ultimate (Additional Music; Nintendo)
 * Unseen Academicals (Audible/Amazon)
 * Alien: Sea of Sorrows
 * Alien: River of Pain (Audible/Amazon)
 * Alien: Out of the Shadows (Audible/Amazon)
 * Dead Space 3 (Electronic Arts)
 * Terraria: Otherworld (as guest composer)
 * Harry Potter and the Order of the Phoenix (EA/Warner Bros. 'Best of 2007', IGN; 'Best VG Score', Movie Music UK Awards 2007).
 * Super Smash Bros. Wii U (Nintendo)
 * Transformers Universe
 * Neverwhere (BBC)
 * RuneScape (Jagex Studio)
 * Good Omens (BBC)
 * Harry Potter and the Deathly Hallows: Part 2 (EA Bright Light Studio)
 * Harry Potter and the Deathly Hallows: Part 1 (EA Bright Light Studio)
 * Command and Conquer: Red Alert 3 (Electronic Arts)
 * Command and Conquer 4: Tiberian Twilight (EA LA)
 * Harry Potter audio books (Nar: Stephen Fry; Pottermore)
 * Primeval (Impossible Pictures/ITV)
 * Art Academy (Nintendo/Headstrong)
 * The Lord of the Rings: Aragorn's Quest (Headstrong/Warner Bros.)
 * Freelancer (Digital Anvil/Microsoft)
 * Harry Potter audiobook series (Read by Stephen Fry; Audible)
 * Harry Potter and the Half-Blood Prince (Electronic Arts/Warner Bros; BAFTA nomination, 2010)
 * Cloudy with a Chance of Meatballs (Ubisoft/Sony Pictures)
 * Saints Row IV (additional music)
 * Evil Genius (VU Games. BAFTA Nomination, Music, 2005)
 * Command and Conquer: Red Alert 3 Uprising (EA LA)
 * Command and Conquer: Red Alert 3 Commander's Challenge (EA LA)
 * Republic The Revolution (Eidos. BAFTA Nomination, Music, 2004)
 * Conquest: Frontier Wars (Digital Anvil/Ubisoft)
 * Dance Moms (Tribal Council, The Hostage)
 * Warhammer: SotHR (Mindscape; Games Workshop)
 * NASCAR Thunder 2004 (2003), Electronic Arts, Inc.
 * NASCAR Racing 2002 Season (2002), Sierra Entertainment, Inc.
 * NASCAR Thunder 2003 (2002), Electronic Arts, Inc.
 * F1 2000 (EA Sports)
 * F1 Manager (EA Sports)
 * FIFA 96, FIFA 98 (EA Sports)
 * Theme Park World (Sim Theme Park in US) (EA/Bullfrog; BAFTA Award, 2000)
 * Hasbro Family Game Night 3 (EA Bright Light)
 * Grand Prix 4 (Infogrames)
 * Brute Force (Digital Anvil/Microsoft. Co-composed with Jesper Kyd and Mike Reagan)
 * Catwoman (EA/Warner Bros.)
 * Reign of Fire (KUJU/BAM)
 * Mr. Bean (VG)
 * Lost In Space (Sound Design; New Line Cinema)
 * Theme Park Inc. (Simcoaster in US) (EA/Bullfrog)
 * Warhammer: Dark Omen (Electronic Arts; Sound Design)
 * Action Man (Hasbro/Intelligent Games; multiple titles in the series)
 * Privateer: The Darkening (Electronic Arts, Origin Systems)
 * FA Premier League Manager(EA Sports; BAFTA Nomination, 2000)''
 * FIFA Soccer Manager (EA Sports)
 * Cutthroat Island (Software Creations)
 * Short Cuts series (Chappell)
 * Big Screen (West One Music)
 * Distorted Reality (Chappell)
 * Jetix (multiple titles in the series)
 * Flight of the Amazon Queen (Renegade)
 * Yamaha SuperCross
 * ATV Racing
 * Infestation (Frontier Developments)
 * MoHo (Lost Toys)
 * Ball Breakers
 * Beasts and Bumpkins (Electronic Arts)
 * Gummy Bears Crazy Golf (Beyond Reality Games)
 * Darklight Conflict (Electronic Arts; additional music)
 * Space Hulk (Electronic Arts/Games Workshop; music for the PlayStation version)

title: James Hannigan