Anaesthesia and Intensive Care Medicine最新文献

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Consent for anaesthesia: considerations in children and young people 麻醉同意：儿童和青少年的注意事项

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.07.002

Niall Tierney, Caoimhe Casby, Barry Lyons

The law relating to consent for medical interventions in children is complex. Children, when they are old or mature enough can consent for themselves, but the legal rules around this vary by jurisdiction. When they are unable to consent, this must be sought from someone with parental responsibility. This article discusses consent, and its refusal, to medical interventions by children, adolescents and parents.

有关同意对儿童进行医疗干预的法律非常复杂。当儿童足够大或足够成熟时，他们可以自己表示同意，但不同司法管辖区对此的法律规定各不相同。当他们无法表示同意时，必须征得负有父母责任的人的同意。本文将讨论儿童、青少年和父母对医疗干预的同意和拒绝。

引用次数: 0

Histamine and antihistamines 组胺和抗组胺剂

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.06.007

Martin Ince, Peter Ruether

Histamine is one of the most important and extensively studied biological molecules in the human body. It plays a constitutive role within almost every bodily system, but most notably within the stomach, where it regulates acid secretion, the central nervous system, where it acts as a neurotransmitter, the cardiovascular system, where it affects cardiac output and vascular permeability, and it has a well-established role in allergy and anaphylaxis. Histamine exerts its effects through four distinct receptor subtypes: H1, H2, H3 and H4. Predominantly, though not exclusively, these take the form of G-protein-coupled receptors. Clinically used antihistamines demonstrate inverse agonism to the histamine receptor and drugs are available with activity at H1, H2 and H3 receptors. H1 antihistamines are used in the treatment of allergy, and are classified as either first or second generation. First-generation antihistamines have significant sedative side effects. H2 antihistamines are predominantly used for the treatment of gastrooesophageal reflux and peptic ulcer disease; however, the most widely used of these, ranitidine, has been withdrawn from use due to (impurity related) safety concerns. H3 antihistamines have been explored for the treatment of neurological disease and to date the only licensed H3 antihistamine is used for the treatment of narcolepsy. Multiple uses have been suggested for H4 antihistamines, including immunomodulation, the treatment of asthma and even as an analgesic. However, no (commercially available) drug exists as of yet.

组胺是人体内最重要、研究最广泛的生物分子之一。它在几乎所有身体系统中都发挥着重要作用，但最明显的是在胃中，它调节胃酸分泌；在中枢神经系统中，它是一种神经递质；在心血管系统中，它影响心输出量和血管通透性；在过敏和过敏性休克中，它也发挥着公认的作用。组胺通过四种不同的受体亚型产生作用：H1、H2、H3 和 H4。这些受体主要是 G 蛋白偶联受体，但并非唯一。临床上使用的抗组胺药对组胺受体具有反向激动作用，并且有药物对 H1、H2 和 H3 受体具有活性。H1 抗组胺药用于治疗过敏，分为第一代和第二代。第一代抗组胺药有明显的镇静副作用。H2 抗组胺药主要用于治疗胃食管反流和消化性溃疡病；然而，其中使用最广泛的雷尼替丁由于（与杂质有关的）安全性问题已停止使用。H3 抗组胺剂已被用于治疗神经系统疾病，迄今为止，唯一获得许可的 H3 抗组胺剂用于治疗嗜睡症。H4 抗组胺药有多种用途，包括免疫调节、治疗哮喘，甚至可用作镇痛剂。不过，目前还没有（市面上有售的）药物。

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引用次数: 0

Recognition of the critically ill patient and escalation of therapy 危重病人的识别和治疗升级

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.06.009

Amy Brown, Apoorva Ballal, Mo Al-Haddad

Critical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standardized approaches which implement an effective ‘chain of response’ are now utilized worldwide. They focus on attempting to reduce the incidence of serious adverse events (SAEs) such as in-hospital cardiac arrest and unplanned intensive care unit (ICU) admission using preventative measures. These systems should include: accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, rapid bedside patient assessment by trained teams and appropriate interventions. Early warning systems (EWS) are an important part of this and can help identify patients at risk of deterioration and SAEs. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized communication framework between professionals. Lastly, timely support and input from members of the critical care team are vital to ensure optimal outcomes for critically ill patients.

危重病通常涉及多个器官衰竭，并与严重的发病率和死亡率相关。在绝大多数病人中，都会有一段明显的生理恶化期，这预示着器官衰竭和危重病的发展。尽管人们在努力改善危重病的检测和管理，但病情恶化的迹象往往会被遗漏，将病人转移到重症监护病房的决定也会被延误。目前，全世界都在使用标准化的方法来实施有效的 "反应链"。这些方法的重点是利用预防性措施来降低严重不良事件（SAE）的发生率，如院内心脏骤停和计划外入住重症监护病房（ICU）。这些系统应包括：准确记录和存档生命体征、识别和解释异常值、由训练有素的团队对患者进行快速床旁评估以及采取适当的干预措施。早期预警系统（EWS）是其中的重要组成部分，可帮助识别有病情恶化和 SAE 风险的病人。危重病人的评估应由经过适当培训的临床医生进行，并遵循结构化 ABCDE（气道、呼吸、循环、残疾和暴露）格式。这有助于优先纠正危及生命的问题，并为专业人员之间的沟通提供标准化框架。最后，重症监护团队成员的及时支持和投入对于确保重症患者获得最佳治疗效果至关重要。

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引用次数: 0

Pharmacological modulation of cardiac function and control of blood vessel calibre 药理调节心脏功能和控制血管口径

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.08.002

John Nicholls, Elliott Bertram-Ralph

The myocardium and vascular system are influenced by the neurological, paracrine and endocrine systems to control blood pressure in health. Blood pressure control is crucial to maintain adequate organ perfusion and function. In disease, the homeostatic mechanisms that control these systems are dysregulated, which can lead to organ failure. Therefore, understanding the means of manipulating these systems using anaesthesia is important. The central nervous system, cardiac muscle and vascular smooth muscle all have physiological processes which can be targeted to reduce the stress response associated with their derangement. This article reviews the different pharmacological means of altering cardiac function and blood vessel calibre to improve organ perfusion.

心肌和血管系统受神经系统、旁分泌系统和内分泌系统的影响，控制健康状态下的血压。血压控制对维持器官充分灌注和功能至关重要。在疾病中，控制这些系统的平衡机制失调，可能导致器官衰竭。因此，了解利用麻醉操纵这些系统的方法非常重要。中枢神经系统、心肌和血管平滑肌都有生理过程，可以针对这些生理过程减少与它们失调相关的应激反应。本文回顾了改变心脏功能和血管口径以改善器官灌注的不同药理手段。

引用次数: 0

Update on ENT anaesthesia in children 儿童耳鼻喉科麻醉的最新进展

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.06.011

Rory W Blackler, Zoë E Brown, Neil K Chadha

This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing proportion are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea (OSA), so judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities, and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including recent advances in ENT surgery that have an impact on the anaesthetist.

本文介绍了儿科耳鼻喉（ENT）常见手术的最新麻醉方法。耳鼻喉科病变是儿童手术最常见的适应症。即使存在阻塞性睡眠呼吸暂停（OSA）等合并症，日间手术的比例也在不断增加，因此明智地选择合适的患儿仍然非常重要。考虑因素包括疾病的严重程度、已知的困难气道、复杂的合并症以及手术中心。将讨论经常进行的儿科耳鼻喉手术的麻醉管理，包括耳鼻喉手术中对麻醉师有影响的最新进展。

引用次数: 0

Haematological problems in intensive care: recent advances and developments 重症监护中的血液学问题：最新进展与发展

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.mpaic.2024.07.004

Samantha Gaw, Christopher J Wright

There have been significant changes in the management of several haematological conditions over the last decade. This article focuses on three key areas – chimeric antigen receptor (CAR) T-cell therapy, haemophagocytic lymphohistiocytosis (HLH) and thrombotic thrombocytopenic purpura (TTP) – and the implications these areas have for clinicians working in intensive care medicine. There is particular focus on CAR T-cell therapy given its novel nature and implications for both critical care practice and resource utilization.

过去十年中，一些血液病的治疗方法发生了重大变化。本文将重点关注三个关键领域--嵌合抗原受体（CAR）T 细胞疗法、嗜血细胞淋巴组织细胞增多症（HLH）和血栓性血小板减少性紫癜（TTP）--以及这些领域对重症医学临床医生的影响。鉴于 CAR T 细胞疗法的新颖性及其对重症监护实践和资源利用的影响，该研究特别关注 CAR T 细胞疗法。

引用次数: 0

Bacterial infections of the respiratory tract and their pharmacological treatment 呼吸道细菌感染及其药物治疗

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-09-01 DOI: 10.1016/j.mpaic.2024.06.006

Abubaker Eltayeb, Susannah Leaver

Bacterial infections of the respiratory tract contribute to significant morbidity and mortality worldwide. Early recognition of lower respiratory tract infections is fundamental for the management and prevention of complications such a sepsis. Common respiratory infections such as community-acquired, hospital-acquired pneumonia, atypical bacterial infection, and acute infective exacerbations of chronic disease such as chronic obstructive pulmonary disease and bronchiectasis are caused by a wide range of pathogens which can be treated in the community or in the hospital setting based on assessment of severity. Antibiotics are by far the most commonly used pharmacological intervention in the management of bacterial infections. Antibiotics have different and unique mechanisms of action against bacteria and several guidelines exist to direct treatment of chest infections. However, with inappropriate use of antibiotics, the resistance of bacteria to antimicrobials has seen significant growth globally, causing concern to the public health. Other pharmacological interventions for the management of infections and sepsis are in the development phase.

呼吸道细菌感染在全球范围内造成了严重的发病率和死亡率。及早发现下呼吸道感染是治疗和预防败血症等并发症的基础。常见的呼吸道感染，如社区获得性肺炎、医院获得性肺炎、非典型细菌感染以及慢性疾病（如慢性阻塞性肺病和支气管扩张症）的急性感染性加重，是由多种病原体引起的，可根据严重程度在社区或医院环境中进行治疗。迄今为止，抗生素是治疗细菌感染最常用的药物干预措施。抗生素对细菌具有不同和独特的作用机制，目前已有几种指导治疗胸部感染的指南。然而，由于抗生素使用不当，全球范围内细菌对抗菌药的耐药性显著增加，引起了公众健康的担忧。用于治疗感染和败血症的其他药物干预措施正处于开发阶段。

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引用次数: 0

Self-assessment 自我评估

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-09-01 DOI: 10.1016/j.mpaic.2024.08.001

Vijayanand Nadella

引用次数: 0

Measurement of respiratory function: gas exchange and its clinical applications 呼吸功能测量：气体交换及其临床应用

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-09-01 DOI: 10.1016/j.mpaic.2024.06.003

Salahuddin M. Qureshi, Rehan Mustafa

Gas exchange is the main function of the lungs. Lungs have a large reserve for gas exchange. Oxygen and carbon dioxide diffuse along their partial pressure gradient across the alveolar–capillary membrane. Alveolar ventilation and pulmonary circulation are closely matched to provide efficient gas exchange in the lungs. Hypoxaemia often results from mismatch in ventilation–perfusion. Gas exchange can be impaired in various disease states. Measurement of the diffusing capacity for carbon monoxide (DLCO) provides estimation of the gas exchange function. A low DLCO indicates an impairment of oxygen transfer across the alveolar–capillary membrane. Based on the lung function tests one can assess the risks of perioperative pulmonary complications. Anaesthesia and surgery adversely affect pulmonary function, many of which adverse effects can be prevented.

气体交换是肺的主要功能。肺有大量的气体交换储备。氧气和二氧化碳沿着其分压梯度在肺泡-毛细血管膜上扩散。肺泡通气和肺循环密切配合，为肺部提供高效的气体交换。低氧血症通常是由于通气-灌注不匹配造成的。在各种疾病状态下，气体交换都会受到影响。测量一氧化碳的弥散能力（DLCO）可估测气体交换功能。一氧化碳弥散容量低表明氧气通过肺泡-毛细血管膜的传输功能受损。根据肺功能检测结果，可以评估围术期肺部并发症的风险。麻醉和手术会对肺功能造成不良影响，其中许多不良影响是可以预防的。

引用次数: 0

Statistics in clinical trials 临床试验统计

IF 0.2 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2024-09-01 DOI: 10.1016/j.mpaic.2024.06.005

Roddy McDermid

This article describes the role of statistics in clinical trials, covering study design, directionality, variables, randomization and blinding, error reduction, probability and ethics as applied to trial design.

本文介绍了统计学在临床试验中的作用，包括研究设计、方向性、变量、随机化和盲法、减少误差、概率以及应用于试验设计的道德规范。

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