Specialists in anaesthesia, analgesia and critical care contribute their expertise to a wide range of clinical cases, from minor surgical procedures through to the most challenging and complex operations, in the emergency situation and in the long term care of the critically ill. To meet the challenges that these cases present the specialty continues to advance and embrace new technologies and procedures, new drugs and equipment, and more innovative programmes of training. In this latest update, the editors and contributors review these developments and drawing on the recent literature address