Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.011
Survival and subsequent good neurological outcome following cardiac arrest depends on prompt diagnosis, good-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and rapid defibrillation, if appropriate. In the post-resuscitation phase, diagnosis and treatment of the underlying cause for the arrest with avoidance of hypotension, hyperthermia, hyperoxia, hyper/hypoglycaemia and management of seizure activity confers the best chances of a successful outcome. Early prognostication of survivors is difficult and should be done by experts using a variety of proven modalities.
{"title":"Cardiopulmonary resuscitation and post-resuscitation care","authors":"","doi":"10.1016/j.mpaic.2024.08.011","DOIUrl":"10.1016/j.mpaic.2024.08.011","url":null,"abstract":"<div><div>Survival and subsequent good neurological outcome following cardiac arrest depends on prompt diagnosis, good-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and rapid defibrillation, if appropriate. In the post-resuscitation phase, diagnosis and treatment of the underlying cause for the arrest with avoidance of hypotension, hyperthermia, hyperoxia, hyper/hypoglycaemia and management of seizure activity confers the best chances of a successful outcome. Early prognostication of survivors is difficult and should be done by experts using a variety of proven modalities.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.012
Understanding the complex process of production, storage and delivery of medical gases is vitally important to ensure safe and efficient practice by anaesthetists. This article discusses the medical gases commonly used in anaesthesia and intensive care and details the journey of the commonly used medical gases from production to patient delivery. It includes core knowledge for the FRCA examinations.
{"title":"Medical gases","authors":"","doi":"10.1016/j.mpaic.2024.08.012","DOIUrl":"10.1016/j.mpaic.2024.08.012","url":null,"abstract":"<div><div>Understanding the complex process of production, storage and delivery of medical gases is vitally important to ensure safe and efficient practice by anaesthetists. This article discusses the medical gases commonly used in anaesthesia and intensive care and details the journey of the commonly used medical gases from production to patient delivery. It includes core knowledge for the FRCA examinations.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.013
Ethical leadership is important for quality healthcare delivery, patient safety and satisfaction, staff engagement and institutional efficiency. Ethical leaders inspire their team, create a culture of respect and a feeling of psychological safety. Failure to adopt an ethical leadership approach can lead to a lack of psychological safety for staff, poor workplace cultures and patient harm.
A doctor who is a good team leader fosters a workplace culture of trust, collaboration, and transparency, whilst holding everyone accountable for their actions. They act with integrity and honesty even when it means making difficult decisions, sharing plans and taking responsibility for any mistakes.
Adopting the principles of ethical leadership early in your clinical career and focussing on developing awareness of the impact of your behaviour on others can help to ensure you deliver the best patient care and become a strong and effective leader.
{"title":"Ethical leadership in healthcare","authors":"","doi":"10.1016/j.mpaic.2024.08.013","DOIUrl":"10.1016/j.mpaic.2024.08.013","url":null,"abstract":"<div><div>Ethical leadership is important for quality healthcare delivery, patient safety and satisfaction, staff engagement and institutional efficiency. Ethical leaders inspire their team, create a culture of respect and a feeling of psychological safety. Failure to adopt an ethical leadership approach can lead to a lack of psychological safety for staff, poor workplace cultures and patient harm.</div><div>A doctor who is a good team leader fosters a workplace culture of trust, collaboration, and transparency, whilst holding everyone accountable for their actions. They act with integrity and honesty even when it means making difficult decisions, sharing plans and taking responsibility for any mistakes.</div><div>Adopting the principles of ethical leadership early in your clinical career and focussing on developing awareness of the impact of your behaviour on others can help to ensure you deliver the best patient care and become a strong and effective leader.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.10.001
{"title":"Self-assessment","authors":"","doi":"10.1016/j.mpaic.2024.10.001","DOIUrl":"10.1016/j.mpaic.2024.10.001","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.004
Pain, agitation and delirium are common during critical illness and are associated with many adverse consequences. A key aim of critical care is the facilitation of a calm, comfortable patient who can interact with their family and staff. Intensive care unit (ICU) patients frequently have pain from a variety of sources, many of which are not readily appreciated or actively managed. This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in the ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will also explore delirium, its risk factors, precipitants and associated morbidity and mortality. This article will discuss how to diagnose delirium and the methods used to prevent and manage it.
{"title":"Pain, agitation and delirium in the intensive care unit","authors":"","doi":"10.1016/j.mpaic.2024.08.004","DOIUrl":"10.1016/j.mpaic.2024.08.004","url":null,"abstract":"<div><div>Pain, agitation and delirium are common during critical illness and are associated with many adverse consequences. A key aim of critical care is the facilitation of a calm, comfortable patient who can interact with their family and staff. Intensive care unit (ICU) patients frequently have pain from a variety of sources, many of which are not readily appreciated or actively managed. This article explores the challenges of assessing pain in the ICU and outlines methods that can be used to better identify and manage pain in this patient group. Agitation in ICU is often multifactorial, with many of its sources under-recognized. We will discuss the potential reasons that ICU patients become agitated, methods for measuring agitation and the actions that can be taken to alleviate it. Although the use of sedative and anxiolytic drugs is common in the ICU, their use is not without risks. This article will outline these risks, the variety of drugs available and how to use these drugs to a targeted effect. We will also explore delirium, its risk factors, precipitants and associated morbidity and mortality. This article will discuss how to diagnose delirium and the methods used to prevent and manage it.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.008
Spinal anaesthesia involves the injection of local anaesthetic solution into the intrathecal space. It is a widely practised anaesthetic technique that can provide surgical anaesthesia for procedures below the umbilicus. Due to the proximity of the central nervous system, safe practice is of paramount importance and requires a good understanding of relevant anatomy, physiology and pharmacology. Complications are rare but need to be recognized and managed rapidly and appropriately.
{"title":"Spinal anaesthesia","authors":"","doi":"10.1016/j.mpaic.2024.08.008","DOIUrl":"10.1016/j.mpaic.2024.08.008","url":null,"abstract":"<div><div>Spinal anaesthesia involves the injection of local anaesthetic solution into the intrathecal space. It is a widely practised anaesthetic technique that can provide surgical anaesthesia for procedures below the umbilicus. Due to the proximity of the central nervous system, safe practice is of paramount importance and requires a good understanding of relevant anatomy, physiology and pharmacology. Complications are rare but need to be recognized and managed rapidly and appropriately.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.007
The addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic although more recently a diverse range of adjuvants have been added to peripheral nerve block solutions, again with the aim of prolonging surgical anaesthesia. The evidence to support or refute the benefit of these agents is increasing, as is our understanding of which agents have demonstrable efficacy and safety at clinically appropriate doses. Clinicians must be aware that many adjuvants are not licensed for central neuraxial or perineural use and should be aware of the risks, in particular of neurotoxicity and unwanted side effects.
{"title":"Adjuvant agents in regional anaesthesia","authors":"","doi":"10.1016/j.mpaic.2024.08.007","DOIUrl":"10.1016/j.mpaic.2024.08.007","url":null,"abstract":"<div><div>The addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic although more recently a diverse range of adjuvants have been added to peripheral nerve block solutions, again with the aim of prolonging surgical anaesthesia. The evidence to support or refute the benefit of these agents is increasing, as is our understanding of which agents have demonstrable efficacy and safety at clinically appropriate doses. Clinicians must be aware that many adjuvants are not licensed for central neuraxial or perineural use and should be aware of the risks, in particular of neurotoxicity and unwanted side effects.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.003
Anaesthesia inhibits a variety of the protective mechanisms usually in place to protect us from harm and prevent damage to vulnerable tissues. In addition, anaesthesia and patient positioning may impose physiological stresses on these tissues. Patients are often required to assume positions for surgery which would be intolerable without anaesthesia; these positions may introduce hazards which can lead to injury. Positioning of patients under anaesthesia is an important subject for anaesthetists to consider, since patient positioning has implications upon the patient’s physiological responses as well as potentially causing injury to the patient. We describe the considerations for the anaesthetist when positioning the surgical patient. We discuss the positions commonly used for surgical patients and relate the challenges associated with each of these positions, challenges which can be physical as well as physiological. Staffing and equipment provision levels must be adequate to cope with the complexity predicted in positioning an individual patient. The anaesthetist also needs to consider the relatively restricted access to the patient for intervention when in the prone or lateral positions.
{"title":"Patient positioning in anaesthesia","authors":"","doi":"10.1016/j.mpaic.2024.08.003","DOIUrl":"10.1016/j.mpaic.2024.08.003","url":null,"abstract":"<div><div>Anaesthesia inhibits a variety of the protective mechanisms usually in place to protect us from harm and prevent damage to vulnerable tissues. In addition, anaesthesia and patient positioning may impose physiological stresses on these tissues. Patients are often required to assume positions for surgery which would be intolerable without anaesthesia; these positions may introduce hazards which can lead to injury. Positioning of patients under anaesthesia is an important subject for anaesthetists to consider, since patient positioning has implications upon the patient’s physiological responses as well as potentially causing injury to the patient. We describe the considerations for the anaesthetist when positioning the surgical patient. We discuss the positions commonly used for surgical patients and relate the challenges associated with each of these positions, challenges which can be physical as well as physiological. Staffing and equipment provision levels must be adequate to cope with the complexity predicted in positioning an individual patient. The anaesthetist also needs to consider the relatively restricted access to the patient for intervention when in the prone or lateral positions.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.015
Managing perioperative anticoagulation and antiplatelet medication is a daily challenge for anaesthetists. Balancing the risks of surgical bleeding and complications of regional anaesthesia must be weighed against time to theatre and the risk of perioperative thrombotic events. The anaesthetist is particularly concerned about compressive vertebral canal haematomas (VCH) which may occur following spinal, epidural or para-vertebral techniques. There is also concern about bleeding complications following peripheral nerve blockade. This article attempts to put the risk of these complications into context and references key international guidelines on peri-procedural management of the broad range of anticoagulant and antiplatelet medication in current use.
{"title":"Regional anaesthesia in patients taking anticoagulant drugs","authors":"","doi":"10.1016/j.mpaic.2024.08.015","DOIUrl":"10.1016/j.mpaic.2024.08.015","url":null,"abstract":"<div><div>Managing perioperative anticoagulation and antiplatelet medication is a daily challenge for anaesthetists. Balancing the risks of surgical bleeding and complications of regional anaesthesia must be weighed against time to theatre and the risk of perioperative thrombotic events. The anaesthetist is particularly concerned about compressive vertebral canal haematomas (VCH) which may occur following spinal, epidural or para-vertebral techniques. There is also concern about bleeding complications following peripheral nerve blockade. This article attempts to put the risk of these complications into context and references key international guidelines on peri-procedural management of the broad range of anticoagulant and antiplatelet medication in current use.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.mpaic.2024.08.010
Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.
{"title":"Central venous cannulation","authors":"","doi":"10.1016/j.mpaic.2024.08.010","DOIUrl":"10.1016/j.mpaic.2024.08.010","url":null,"abstract":"<div><div>Central venous cannulation using the basic principles of the Seldinger technique is a core skill for anaesthetists and critical care doctors in situations where intravenous access is difficult or multiple infusions are required. While potentially lifesaving, central venous cannulation carries the risk of serious morbidity (or even mortality). Mitigating these risks through aseptic technique, ultrasound guidance and timely management of complications is vital.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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