Pub Date : 2024-12-01DOI: 10.1016/j.mpaic.2024.09.004
Áine McCarthy, Brian Harte
Breathing systems are designed to deliver oxygen, air and anaesthetic agent to the patient, and, in the case of circle systems, allow the recycling of expired gases after removal of CO2. A relatively small number of distinct breathing varieties are used in modern practice. They consist of similar components but in different configurations, with the layout of each determining their clinical attributes and preferred role. Various classification systems will be described in this article. Modern anaesthesia machines primarily use circle systems with CO2 absorbers designed for low-flow anaesthesia.
{"title":"Anaesthetic breathing systems","authors":"Áine McCarthy, Brian Harte","doi":"10.1016/j.mpaic.2024.09.004","DOIUrl":"10.1016/j.mpaic.2024.09.004","url":null,"abstract":"<div><div>Breathing systems are designed to deliver oxygen, air and anaesthetic agent to the patient, and, in the case of circle systems, allow the recycling of expired gases after removal of CO<sub>2</sub>. A relatively small number of distinct breathing varieties are used in modern practice. They consist of similar components but in different configurations, with the layout of each determining their clinical attributes and preferred role. Various classification systems will be described in this article. Modern anaesthesia machines primarily use circle systems with CO<sub>2</sub> absorbers designed for low-flow anaesthesia.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 12","pages":"Pages 818-822"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152603","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 : 2024-12-01DOI: 10.1016/j.mpaic.2024.09.002
Liam Sheppard, James Barrowman
Total intravenous anaesthesia (TIVA) is the induction and maintenance of general anaesthesia exclusively via intravenous anaesthetic agents. TIVA provides an anaesthetic alternative when inhalational agents are relatively or absolutely contraindicated and is also used in a number of practical situations where delivery of inhalational anaesthetic is not feasible, such as during patient transfers. It is essential that all anaesthetists understand the pharmacokinetic principles involved with TIVA and are confident in their ability to deliver TIVA safely. This article describes the key pharmacokinetic principles and models used for TIVA, practical and safety aspects during its use, and paediatric TIVA.
{"title":"Total intravenous anaesthesia","authors":"Liam Sheppard, James Barrowman","doi":"10.1016/j.mpaic.2024.09.002","DOIUrl":"10.1016/j.mpaic.2024.09.002","url":null,"abstract":"<div><div>Total intravenous anaesthesia (TIVA) is the induction and maintenance of general anaesthesia exclusively via intravenous anaesthetic agents. TIVA provides an anaesthetic alternative when inhalational agents are relatively or absolutely contraindicated and is also used in a number of practical situations where delivery of inhalational anaesthetic is not feasible, such as during patient transfers. It is essential that all anaesthetists understand the pharmacokinetic principles involved with TIVA and are confident in their ability to deliver TIVA safely. This article describes the key pharmacokinetic principles and models used for TIVA, practical and safety aspects during its use, and paediatric TIVA.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 12","pages":"Pages 850-855"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152606","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 : 2024-12-01DOI: 10.1016/j.mpaic.2024.09.003
Zahra Essackjee, Joseph Sebastian
Inhalational anaesthesia is conducted via the use of volatile agents and predates the use of intravenous anaesthesia. Volatile agents can be used to induce and maintain anaesthesia; the choice of agent relies on an understanding of the individual physical properties of each agent. This article describes these properties including the blood: gas coefficient, oil: gas coefficient, minimum alveolar concentration (MAC) and saturated vapour pressure (SVP). Delivery of inhalational anaesthesia to the patient and depth of anaesthesia monitoring is then discussed together with vaporizer function. Lastly, there is a discussion of the environmental impact of inhalational agents including nitrous oxide with reference to the proposed future agent xenon.
{"title":"Inhalational anaesthesia","authors":"Zahra Essackjee, Joseph Sebastian","doi":"10.1016/j.mpaic.2024.09.003","DOIUrl":"10.1016/j.mpaic.2024.09.003","url":null,"abstract":"<div><div>Inhalational anaesthesia is conducted via the use of volatile agents and predates the use of intravenous anaesthesia. Volatile agents can be used to induce and maintain anaesthesia; the choice of agent relies on an understanding of the individual physical properties of each agent. This article describes these properties including the blood: gas coefficient, oil: gas coefficient, minimum alveolar concentration (MAC) and saturated vapour pressure (SVP). Delivery of inhalational anaesthesia to the patient and depth of anaesthesia monitoring is then discussed together with vaporizer function. Lastly, there is a discussion of the environmental impact of inhalational agents including nitrous oxide with reference to the proposed future agent xenon.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 12","pages":"Pages 856-860"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152600","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}
This review outlines the fundamental principles of mechanical ventilation and offers a guide on the use of the main ventilatory settings in controlled and assisted ventilatory modes. Next, the main measurements that are made by modern ventilators of respiratory system mechanics are explained.
{"title":"Principles of artificial ventilation","authors":"Gianmarco Carenini, Claudio Ripa, Emanuele Rezoagli","doi":"10.1016/j.mpaic.2024.09.009","DOIUrl":"10.1016/j.mpaic.2024.09.009","url":null,"abstract":"<div><div>This review outlines the fundamental principles of mechanical ventilation and offers a guide on the use of the main ventilatory settings in controlled and assisted ventilatory modes. Next, the main measurements that are made by modern ventilators of respiratory system mechanics are explained.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 12","pages":"Pages 804-812"},"PeriodicalIF":0.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143152608","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.2024.08.011
Michael O’Connor, C Stephanie Cattlin
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":"Michael O’Connor, C Stephanie Cattlin","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":"25 11","pages":"Pages 781-785"},"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
William Malein, Christina Beecroft
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":"William Malein, Christina Beecroft","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":"25 11","pages":"Pages 753-757"},"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
Daniele C Bryden
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":"Daniele C Bryden","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":"25 11","pages":"Pages 792-795"},"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
Vijayanand Nadella
{"title":"Self-assessment","authors":"Vijayanand Nadella","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":"25 11","pages":"Pages 796-797"},"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
Christopher McGovern, Richard Cowan, Richard Appleton, Barbara Miles
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":"Christopher McGovern, Richard Cowan, Richard Appleton, Barbara Miles","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":"25 11","pages":"Pages 773-780"},"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.2024.08.007
Mark Gallagher, Calum RK Grant
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":"Mark Gallagher, Calum RK Grant","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":"25 11","pages":"Pages 768-772"},"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}
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