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Adverse drug reactions 药物不良反应
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.012
Jonathan Evans, Matthew Robinson, Muataz Amare
Adverse drug reactions (ADRs) are a response to a drug that is noxious and unintended. They are a frequent cause of hospitalization and mortality in the UK, resulting in a significant financial burden for the NHS. Between one-third to a half of ADRs are avoidable. To minimize their occurrence, each patient's susceptibility should be assessed by evaluating risk factors such as age, co-morbidities and potential drug interactions before a medication is administered. Pharmacogenomics is an area of increasing interest that has been emphasized in the NHS 10-year health plan. A profile of a limited number genetic loci can provide vital information for safe prescribing of numerous common medications. This will enable clinicians to target drugs and dosages to the patients they are likely to benefit and reduce the risk of ADRs.
Anaesthetists and intensivists hold a crucial role in managing ADRs. Firstly, we are responsible for patient safety throughout the perioperative period, during which we often administer multiple medications which could potentially cause an ADR. Fortunately, we also meticulously observe physiological changes during this period, increasing the likelihood of detecting such events. Secondly, several ‘atypical’ drug reactions, such as anaphylaxis and toxic epidermal necrolysis, are so severe that they often necessitate management in an intensive care environment. Therefore, we have a professional responsibility to ensure we are familiar with recognizing, managing, and reporting ADRs.
药物不良反应(adr)是对有害和非预期药物的反应。它们是英国住院和死亡的常见原因,给NHS带来了沉重的经济负担。三分之一到一半的adr是可以避免的。为了尽量减少其发生,在给药前应通过评估年龄、合并症和潜在的药物相互作用等风险因素来评估每位患者的易感性。药物基因组学是一个日益受到关注的领域,已在NHS 10年健康计划中得到强调。对有限数量的基因位点的分析可以为许多常用药物的安全处方提供重要信息。这将使临床医生能够针对他们可能受益的患者靶向药物和剂量,并降低不良反应的风险。麻醉师和重症监护师在处理不良反应方面发挥着至关重要的作用。首先,我们对整个围手术期的患者安全负责,在此期间我们经常使用多种可能导致不良反应的药物。幸运的是,我们还仔细观察了这一时期的生理变化,增加了发现此类事件的可能性。其次,一些“非典型”药物反应,如过敏反应和中毒性表皮坏死松解,非常严重,通常需要在重症监护环境中进行管理。因此,我们有专业责任确保我们熟悉adr的识别、管理和报告。
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引用次数: 0
Factors affecting drug absorption and distribution 影响药物吸收和分布的因素
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.002
Elliott Bertram-Ralph, Muataz Amare
Pharmacokinetics describes the processes that underpin how the human body handles a drug. There are four elements to pharmacokinetics: absorption, distribution, metabolism, and excretion. Drug absorption involves the movement of the drug across a cell membrane and is largely dependent on diffusion. The absorption rate is determined by the preparation of the drug, route of administration, size of the molecule, concentration gradient, degree of protein binding and lipid solubility of the drug. First pass metabolism can be responsible for reducing the bioavailability of drugs via certain routes like oral administration.
Different compartment models can be used to predict the pharmacokinetic process of drug distribution. Multicompartmental models are used to understand how the drug is distributed to model the uptake of the drug into different tissues at varying rates. These models are utilized for targeted controlled infusions in practice to maintain anaesthesia at an effect site concentration that is specified by the user.
药代动力学描述了支撑人体处理药物的过程。药代动力学有四个要素:吸收、分布、代谢和排泄。药物吸收涉及药物穿过细胞膜的运动,很大程度上依赖于扩散。吸收率由药物的制备、给药途径、分子大小、浓度梯度、蛋白质结合程度和药物的脂溶性决定。通过口服给药等途径,首过代谢会降低药物的生物利用度。不同的室模型可用于预测药物分布的药代动力学过程。多室模型用于了解药物如何分布,以模拟药物以不同速率进入不同组织的摄取。这些模型在实践中用于有针对性的控制输注,以将麻醉维持在用户指定的作用部位浓度。
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引用次数: 0
Processing, storage and display of physiology 生理学的加工、储存和展示
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.010
Adam Kirk, Thomas Clayton
Anaesthetists rely on sophisticated monitoring systems to guide anaesthetic management and respond to physiological changes in real time. The display of physiological data is varied, encompassing numerical values, waveforms, traces, and audible signals – each of which demands our attention in different ways. These visual and auditory cues are integral to detecting critical shifts in a patient's condition. This article explores the signal-processing pathway, breaking down the methods by which anaesthetists filter and prioritize these physiological signals. We focus on how certain signals are manipulated and interpreted to provide meaningful information, while others are automatically disregarded. Through this lens, we examine the techniques and strategies employed to hone in on the most relevant data, ensuring prompt and accurate responses to dynamic clinical scenarios.
麻醉师依靠复杂的监测系统来指导麻醉管理,并实时对生理变化做出反应。生理数据的显示是多种多样的,包括数值、波形、轨迹和声音信号——每一种都以不同的方式需要我们的注意。这些视觉和听觉线索对于检测患者病情的关键变化是不可或缺的。本文探讨了信号处理途径,分解了麻醉师过滤和优先处理这些生理信号的方法。我们关注的是某些信号是如何被操纵和解释以提供有意义的信息,而其他信号则被自动忽略。通过这个镜头,我们研究了用于磨练最相关数据的技术和策略,确保对动态临床场景做出及时准确的反应。
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引用次数: 0
Mechanisms of drug interactions II: pharmacokinetics and pharmacodynamics 药物相互作用机制II:药代动力学和药效学
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.001
Gurjit S. Rai, Christopher J. Rozario
This article complements that of Corrie and Hardman (2011) as it dwells specifically on drug interactions in pharmacokinetics. It emphasizes how pharmacokinetics is influenced by drug–drug and drug–disease interactions. Common examples, in anaesthesia and intensive care settings, are illustrated. It then concludes in reaffirming pharmacodynamic interactions in the article cited.
这篇文章补充了Corrie和Hardman(2011)的文章,因为它专门讨论了药代动力学中的药物相互作用。它强调药代动力学如何受到药物-药物和药物-疾病相互作用的影响。举例说明了在麻醉和重症监护环境中常见的例子。最后重申引用文章中的药效学相互作用。
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引用次数: 0
Mechanics 力学
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.009
Victor Bill, Bruce Liu, Ming Wilson
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引用次数: 0
Electricity and magnetism 电与磁
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.008
Jennifer Roe, Steve Roberts
This article introduces the key concepts of electricity, electrical circuits and their practical applications to anaesthesia and patient safety. The principles of mass spectrometry and magnetic resonance imaging are also discussed.
本文介绍了电学、电路的关键概念及其在麻醉和患者安全方面的实际应用。讨论了质谱和磁共振成像的原理。
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引用次数: 0
Mathematical concepts 数学概念
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.007
Samuel Owen, Heather Gallie
This article explores the mathematical foundations underpinning drug pharmacokinetics and pharmacodynamics in anaesthesia, focusing on the application of linear and non-linear relationships. Key concepts such as wash-in, wash-out, and tear-away functions, alongside the three-compartment pharmacokinetic model, are explored to highlight their relevance to clinical practice. These principles, fundamental for the Fellowship of the Royal College of Anaesthetists (FRCA) curriculum, are often underappreciated in day-to-day anaesthesia yet play a foundational role in almost everything anaesthetists undertake daily. We will explore the basics of how mathematical formulas apply to total intravenous anaesthesia (TIVA) through target-controlled infusion (TCI) models and context-sensitive half-time (CSHT).
本文探讨了麻醉中药物药代动力学和药效学的数学基础,重点介绍了线性和非线性关系的应用。关键概念,如冲入,冲出和撕裂功能,以及三室药代动力学模型,探索突出其与临床实践的相关性。这些原则是皇家麻醉师学院(FRCA)课程的基础,在日常麻醉中经常被低估,但在麻醉师每天承担的几乎所有事情中都发挥着基础作用。我们将通过靶控输注(TCI)模型和上下文敏感的半场时间(CSHT)来探讨数学公式如何应用于全静脉麻醉(TIVA)的基础知识。
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引用次数: 0
Antidepressants and antipsychotics 抗抑郁药和抗精神病药
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.003
James Barrowman, Ming Wilson
Mental health disorders represent the most common cause of disability in the UK with one in four adults affected each year. Despite this prevalence, there remains a lack of knowledge and understanding of the various pharmacological agents used to treat these disorders, and how they may affect anaesthetic management. This article aims to summarize the pharmacological effects of frequently used psychoactive drugs and how these affect anaesthetic management during the perioperative period.
在英国,精神健康障碍是导致残疾的最常见原因,每年有四分之一的成年人受到影响。尽管如此,人们仍然缺乏对用于治疗这些疾病的各种药理学药物的知识和理解,以及它们如何影响麻醉管理。本文旨在总结常用的精神活性药物的药理作用及其对围手术期麻醉管理的影响。
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引用次数: 0
Self-assessment 自我评估
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.011
Vijayanand Nadella
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引用次数: 0
SI units
IF 0.3 Q4 ANESTHESIOLOGY Pub Date : 2026-01-01 DOI: 10.1016/j.mpaic.2025.11.006
Mohamed Radwan, James Barrowman
Anaesthetists perform and utilize multiple measurements every day during their clinical practice. This can vary from simply recording a patient's weight to determine drug doses, to complex monitoring devices that display vital parameters during anaesthesia. This article explores the history and key principles of measurement using the International System of Units or Système International (SI), along with the scientific basis for each defining constant. Frequently used derived units and non-SI units are explained, with their application to mechanical ventilation providing a clinical context. Potential future advances are also given.
麻醉师在临床实践中每天都要进行多次测量。这可以从简单地记录病人的体重来确定药物剂量,到在麻醉期间显示重要参数的复杂监测设备。本文探讨了使用国际单位制或国际单位制(SI)进行测量的历史和关键原理,以及每个定义常数的科学依据。经常使用的衍生单位和非si单位解释,与他们的应用机械通气提供临床背景。展望了未来的发展趋势。
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引用次数: 0
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Anaesthesia and Intensive Care Medicine
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