Pub Date : 2025-11-01DOI: 10.1016/j.mpaic.2025.10.008
Mahmoud Ali, Philip Arnold
Congenital heart disease occurs in approximately 8 in every 1000 births, making it the most common significant congenital abnormality. There is a wide range of lesions and the impact of these during neonatal life will be extremely variable: some will require major cardiac surgery in the first weeks of life, whilst other lesions will have little impact on the child’s health. Cardiac disease also has implications for management, and outcome, of neonates undergoing non-cardiac surgery.
{"title":"Cardiac disease in neonates","authors":"Mahmoud Ali, Philip Arnold","doi":"10.1016/j.mpaic.2025.10.008","DOIUrl":"10.1016/j.mpaic.2025.10.008","url":null,"abstract":"<div><div>Congenital heart disease occurs in approximately 8 in every 1000 births, making it the most common significant congenital abnormality. There is a wide range of lesions and the impact of these during neonatal life will be extremely variable: some will require major cardiac surgery in the first weeks of life, whilst other lesions will have little impact on the child’s health. Cardiac disease also has implications for management, and outcome, of neonates undergoing non-cardiac surgery.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 774-778"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528134","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 : 2025-11-01DOI: 10.1016/j.mpaic.2025.10.003
Sarada Gurung, Rhiann M O'Shaughnessy
Neonates possess unique physiological characteristics as they transition from intrauterine to extrauterine life. According to the National Audit Project (NAP) 7, neonates are particularly vulnerable to perioperative cardiac arrest, with an incidence of 1 in 200 compared to 1 in 3333 in the paediatric population. A thorough understanding of their physiology is crucial for providing high-quality perioperative care. Prematurity and low birth weight are two significant risk factors that contribute to increased perioperative morbidity and mortality. It is essential to actively manage temperature and glucose levels. While a term neonate with a postmenstrual age (PMA) of 44 weeks may be suitable for day-surgical care, preterm infants often require inpatient admission until they reach a PMA of 60 weeks.
{"title":"Principles of anaesthesia for neonates","authors":"Sarada Gurung, Rhiann M O'Shaughnessy","doi":"10.1016/j.mpaic.2025.10.003","DOIUrl":"10.1016/j.mpaic.2025.10.003","url":null,"abstract":"<div><div>Neonates possess unique physiological characteristics as they transition from intrauterine to extrauterine life. According to the National Audit Project (NAP) 7, neonates are particularly vulnerable to perioperative cardiac arrest, with an incidence of 1 in 200 compared to 1 in 3333 in the paediatric population. A thorough understanding of their physiology is crucial for providing high-quality perioperative care. Prematurity and low birth weight are two significant risk factors that contribute to increased perioperative morbidity and mortality. It is essential to actively manage temperature and glucose levels. While a term neonate with a postmenstrual age (PMA) of 44 weeks may be suitable for day-surgical care, preterm infants often require inpatient admission until they reach a PMA of 60 weeks.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 739-744"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528129","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 : 2025-11-01DOI: 10.1016/j.mpaic.2025.10.011
Paige McGregor, Eilidh Lynch, Andrea Llano
Diabetes is a chronic metabolic disorder characterized by hyperglycaemia which results from insulin deficiency and/or increased resistance to endogenous insulin. Its management is with lifestyle, dietary and pharmacological interventions with the aim of improving glycaemic control and reducing cardiovascular risk and microvascular complications. Newer agents such as glucagon-like peptide 1 receptor agonists and sodium–glucose transporter 2 inhibitors have been shown to improve glycaemic control, promote weight loss and have additional cardio-renal benefits. In this article, drugs used in the treatment of diabetes will be reviewed, including side effects and alterations required in the perioperative period.
{"title":"Drugs used in the management of hyperglycaemia","authors":"Paige McGregor, Eilidh Lynch, Andrea Llano","doi":"10.1016/j.mpaic.2025.10.011","DOIUrl":"10.1016/j.mpaic.2025.10.011","url":null,"abstract":"<div><div>Diabetes is a chronic metabolic disorder characterized by hyperglycaemia which results from insulin deficiency and/or increased resistance to endogenous insulin. Its management is with lifestyle, dietary and pharmacological interventions with the aim of improving glycaemic control and reducing cardiovascular risk and microvascular complications. Newer agents such as glucagon-like peptide 1 receptor agonists and sodium–glucose transporter 2 inhibitors have been shown to improve glycaemic control, promote weight loss and have additional cardio-renal benefits. In this article, drugs used in the treatment of diabetes will be reviewed, including side effects and alterations required in the perioperative period.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 792-796"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528137","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 : 2025-11-01DOI: 10.1016/j.mpaic.2025.10.012
Vijayanand Nadella
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.10.012","DOIUrl":"10.1016/j.mpaic.2025.10.012","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 797-798"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528138","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.004
Sean Rayappu, Valpuri Luoma, Ugan Reddy
An acute ischaemic stroke (AIS) is a non-specific state of brain injury with neuronal dysfunction, which has several pathophysiological causes and is time critical. More than 60% of cases are due to thrombotic or embolic causes with resultant focal ischaemia and an accompanying neurological deficit. Initial assessment, stabilization and early imaging are important aspects of effective stroke management. Thrombolysis and endovascular thrombectomy have proven beneficial in reversing neurological deficits and improving functional outcomes. Guidelines now support administration of recombinant tissue plasminogen activator (rt-PA) up to 4.5 hours and extension of endovascular thrombectomy (EVT) windows up to 24 hours after onset of symptoms in select patient groups. Other important aspects of management include administration of antiplatelet agents (aspirin) within 48 hours, management within a specialist stroke unit, and decompressive craniectomy for malignant middle cerebral artery (MCA) stroke.
{"title":"Acute management of ischaemic stroke","authors":"Sean Rayappu, Valpuri Luoma, Ugan Reddy","doi":"10.1016/j.mpaic.2025.08.004","DOIUrl":"10.1016/j.mpaic.2025.08.004","url":null,"abstract":"<div><div>An acute ischaemic stroke (AIS) is a non-specific state of brain injury with neuronal dysfunction, which has several pathophysiological causes and is time critical. More than 60% of cases are due to thrombotic or embolic causes with resultant focal ischaemia and an accompanying neurological deficit. Initial assessment, stabilization and early imaging are important aspects of effective stroke management. Thrombolysis and endovascular thrombectomy have proven beneficial in reversing neurological deficits and improving functional outcomes. Guidelines now support administration of recombinant tissue plasminogen activator (rt-PA) up to 4.5 hours and extension of endovascular thrombectomy (EVT) windows up to 24 hours after onset of symptoms in select patient groups. Other important aspects of management include administration of antiplatelet agents (aspirin) within 48 hours, management within a specialist stroke unit, and decompressive craniectomy for malignant middle cerebral artery (MCA) stroke.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 625-632"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323920","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.006
Enrico Sorrentino, Jennifer Lewis
Spontaneous intracerebral haemorrhage (ICH) is a devastating form of stroke that carries a high risk of disability and mortality. The main risk factor is chronic arterial hypertension, but it can also be secondary to micro- and macrovascular causes. Patients with ICH should be looked after on an acute stroke unit or on an intensive care unit. Their management is complex and involves stroke physicians, neurointensivists and neurosurgeons, as well as several allied health professionals. The mainstays of medical treatment are blood pressure control and reversal of anticoagulation. Surgical management has traditionally been confined to a small number of cases, but recent promising technological enhancements are allowing the benefits of surgical care to be extended to more patients.
{"title":"Spontaneous intracerebral haemorrhage","authors":"Enrico Sorrentino, Jennifer Lewis","doi":"10.1016/j.mpaic.2025.08.006","DOIUrl":"10.1016/j.mpaic.2025.08.006","url":null,"abstract":"<div><div>Spontaneous intracerebral haemorrhage (ICH) is a devastating form of stroke that carries a high risk of disability and mortality. The main risk factor is chronic arterial hypertension, but it can also be secondary to micro- and macrovascular causes. Patients with ICH should be looked after on an acute stroke unit or on an intensive care unit. Their management is complex and involves stroke physicians, neurointensivists and neurosurgeons, as well as several allied health professionals. The mainstays of medical treatment are blood pressure control and reversal of anticoagulation. Surgical management has traditionally been confined to a small number of cases, but recent promising technological enhancements are allowing the benefits of surgical care to be extended to more patients.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 633-638"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323973","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.007
Elouise S Donaldson, Eleanor L Carter
The brain is an exquisitely sensitive organ, requiring a constant supply of blood, oxygen, and glucose to function. Cerebral blood flow is autoregulated to provide a near constant blood supply despite fluctuations in whole body physiology. The blood–brain barrier acts to ensure that the brain microenvironment remains tightly regulated. The pressure within the cranium must also be tightly controlled to maintain optimal cerebral perfusion and ultimately prevent herniation of brain parenchyma. Several physiological parameters can be monitored including intracranial pressure, cerebral oxygenation and metabolic stress and clinical use is increasing including in traumatic brain injury and subarachnoid haemorrhage patients.
{"title":"Applied cerebral physiology","authors":"Elouise S Donaldson, Eleanor L Carter","doi":"10.1016/j.mpaic.2025.08.007","DOIUrl":"10.1016/j.mpaic.2025.08.007","url":null,"abstract":"<div><div>The brain is an exquisitely sensitive organ, requiring a constant supply of blood, oxygen, and glucose to function. Cerebral blood flow is autoregulated to provide a near constant blood supply despite fluctuations in whole body physiology. The blood–brain barrier acts to ensure that the brain microenvironment remains tightly regulated. The pressure within the cranium must also be tightly controlled to maintain optimal cerebral perfusion and ultimately prevent herniation of brain parenchyma. Several physiological parameters can be monitored including intracranial pressure, cerebral oxygenation and metabolic stress and clinical use is increasing including in traumatic brain injury and subarachnoid haemorrhage patients.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 683-688"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323928","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.003
Daniel Lunardi, Judith Dinsmore
Awake craniotomy enables intraoperative assessment of a patient's neurological status. It is most commonly performed for the resection of tumours within eloquent cortex, and it is now considered a standard of care. Other indications include epilepsy surgery and neuromodulation for the treatment of Parkinson's disease, tremor, dystonia, and other intractable movement disorders.
Paradoxically, providing anaesthesia for an ‘awake’ procedure, presents particular challenges for the anaesthetist. Although safe and well tolerated, complications occur which can be reduced by meticulous planning and good communication. An understanding of the stages of the surgical procedure and their unique anaesthetic requirements is required. Various anaesthetic techniques are described but there is no one optimal technique. Each case requires individual planning with regards to most suitable technique. Many drugs can be used to deliver sedation, analgesia, or anaesthesia, each requiring finesse with dosing and titration. Effective local anaesthesia is essential no matter what technique is chosen. Awake craniotomies are rewarding cases, with clear benefits in terms of improved patient outcomes and reduction in hospital stay and costs.
{"title":"Anaesthesia for awake craniotomy","authors":"Daniel Lunardi, Judith Dinsmore","doi":"10.1016/j.mpaic.2025.08.003","DOIUrl":"10.1016/j.mpaic.2025.08.003","url":null,"abstract":"<div><div>Awake craniotomy enables intraoperative assessment of a patient's neurological status. It is most commonly performed for the resection of tumours within eloquent cortex, and it is now considered a standard of care. Other indications include epilepsy surgery and neuromodulation for the treatment of Parkinson's disease, tremor, dystonia, and other intractable movement disorders.</div><div>Paradoxically, providing anaesthesia for an ‘awake’ procedure, presents particular challenges for the anaesthetist. Although safe and well tolerated, complications occur which can be reduced by meticulous planning and good communication. An understanding of the stages of the surgical procedure and their unique anaesthetic requirements is required. Various anaesthetic techniques are described but there is no one optimal technique. Each case requires individual planning with regards to most suitable technique. Many drugs can be used to deliver sedation, analgesia, or anaesthesia, each requiring finesse with dosing and titration. Effective local anaesthesia is essential no matter what technique is chosen. Awake craniotomies are rewarding cases, with clear benefits in terms of improved patient outcomes and reduction in hospital stay and costs.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 695-701"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323925","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.011
Dean C Semmens, Jennifer B Stott
Receptors and ion channels are key targets for commonly used drugs in anaesthesia and intensive care medicine, with drugs interacting with targets as agonists, antagonists or inverse agonists to exert their physiological effects. This article introduces the basic concepts of drug affinity, efficacy and potency and how these principals relate to the mechanism of action of select drugs. Drug–receptor interaction is described for intracellular receptors, nuclear receptors and G-protein-coupled receptors (GPCRs), including a discussion of receptor structure and examples of intracellular signaling pathways that control cellular function. The article also explores voltage-gated and ligand-gated ion channels, with discussion of how the activity of these ion channels is governed by changes in the membrane potential. Voltage-gated sodium, potassium and calcium ion channels are discussed, in addition to major excitatory (e.g. N-methyl-D-aspartate (NMDA) receptors) and inhibitory (e.g. γ-aminobutyric acid A (GABAA) receptors) ligand-gated ion channels that constitute targets for a variety of drugs including examples used in anaesthesia and intensive care medicine.
{"title":"Ion channels, receptors, agonists and antagonists","authors":"Dean C Semmens, Jennifer B Stott","doi":"10.1016/j.mpaic.2025.08.011","DOIUrl":"10.1016/j.mpaic.2025.08.011","url":null,"abstract":"<div><div>Receptors and ion channels are key targets for commonly used drugs in anaesthesia and intensive care medicine, with drugs interacting with targets as agonists, antagonists or inverse agonists to exert their physiological effects. This article introduces the basic concepts of drug affinity, efficacy and potency and how these principals relate to the mechanism of action of select drugs. Drug–receptor interaction is described for intracellular receptors, nuclear receptors and G-protein-coupled receptors (GPCRs), including a discussion of receptor structure and examples of intracellular signaling pathways that control cellular function. The article also explores voltage-gated and ligand-gated ion channels, with discussion of how the activity of these ion channels is governed by changes in the membrane potential. Voltage-gated sodium, potassium and calcium ion channels are discussed, in addition to major excitatory (e.g. N-methyl-D-aspartate (NMDA) receptors) and inhibitory (e.g. γ-aminobutyric acid A (GABA<sub>A</sub>) receptors) ligand-gated ion channels that constitute targets for a variety of drugs including examples used in anaesthesia and intensive care medicine.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 709-716"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326910","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 : 2025-10-01DOI: 10.1016/j.mpaic.2025.08.009
Thom O’Dell, Anastasia Papadaki, Sally R. Wilson
Magnetic resonance imaging (MRI) is a widely available imaging modality providing high-resolution images of soft tissues. The magnetic fields generated by these scanners create an array of safety challenges which require specialist equipment and trained staff to safely operate within this environment.
Guidance exists for the anaesthetist working in the MR suite, though for many individuals it remains a less familiar environment and remote site for practising safe anaesthesia.
We outline the specific concerns with commonly encountered implanted devices and some of the practicalities related to caring for patients with these devices in the MRI suite.
Within neuroanaesthesia, advances in procedural techniques and technology in MRI lead to an increased number of patients requiring scanning for diagnosis and treatment progress.
This includes patients on the critical care unit and intraoperatively in the interventional MRI suites.
{"title":"Anaesthesia in the MRI unit","authors":"Thom O’Dell, Anastasia Papadaki, Sally R. Wilson","doi":"10.1016/j.mpaic.2025.08.009","DOIUrl":"10.1016/j.mpaic.2025.08.009","url":null,"abstract":"<div><div>Magnetic resonance imaging (MRI) is a widely available imaging modality providing high-resolution images of soft tissues. The magnetic fields generated by these scanners create an array of safety challenges which require specialist equipment and trained staff to safely operate within this environment.</div><div>Guidance exists for the anaesthetist working in the MR suite, though for many individuals it remains a less familiar environment and remote site for practising safe anaesthesia.</div><div>We outline the specific concerns with commonly encountered implanted devices and some of the practicalities related to caring for patients with these devices in the MRI suite.</div><div>Within neuroanaesthesia, advances in procedural techniques and technology in MRI lead to an increased number of patients requiring scanning for diagnosis and treatment progress.</div><div>This includes patients on the critical care unit and intraoperatively in the interventional MRI suites.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 10","pages":"Pages 702-708"},"PeriodicalIF":0.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326911","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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