Pub Date : 2025-11-01DOI: 10.1016/j.mpaic.2025.10.005
Bryan Atandi, James Masters, Philip Arnold
Neonates may require painful procedures whilst in hospital. Anaesthetists may be called upon to help manage neonates in pain. Developmental differences in anatomy and physiology cause challenges when considering appropriate analgesic strategies. A multimodal approach, with careful modification of established analgesic practices, is required to both minimize the negative sequelae of pain and limit adverse effects. Those tasked with the care of neonates should be familiar with the different analgesic options at their disposal, utilizing a combination of non-pharmacologic, pharmacologic and interventional strategies in order to improve patient care.
{"title":"Acute pain management in the neonate","authors":"Bryan Atandi, James Masters, Philip Arnold","doi":"10.1016/j.mpaic.2025.10.005","DOIUrl":"10.1016/j.mpaic.2025.10.005","url":null,"abstract":"<div><div>Neonates may require painful procedures whilst in hospital. Anaesthetists may be called upon to help manage neonates in pain. Developmental differences in anatomy and physiology cause challenges when considering appropriate analgesic strategies. A multimodal approach, with careful modification of established analgesic practices, is required to both minimize the negative sequelae of pain and limit adverse effects. Those tasked with the care of neonates should be familiar with the different analgesic options at their disposal, utilizing a combination of non-pharmacologic, pharmacologic and interventional strategies in order to improve patient care.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 753-758"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528131","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.2025.10.007
Jacinth Tan, Katie Misselbrook
Neonates present a specific set of challenges to the anaesthetist due to neonatal anatomy and physiology that is very different from that in children and adults. These challenges increase when the neonate is premature, but also if they have associated co-morbidities. There are certain medical conditions that exclusively affect neonates, or that affects neonates more commonly and significantly. When they present for anaesthesia and surgery, it is essential that the anaesthetist understands the implications of these co-morbid problems. A multidisciplinary approach involving neonatologists and other sub-specialists should be sought to ensure safe perioperative management of the ongoing medical issue. This article aims to address some common medical diagnoses and considerations for safe anaesthesia in these babies.
{"title":"Medical illnesses in neonates: implications for anaesthesia","authors":"Jacinth Tan, Katie Misselbrook","doi":"10.1016/j.mpaic.2025.10.007","DOIUrl":"10.1016/j.mpaic.2025.10.007","url":null,"abstract":"<div><div>Neonates present a specific set of challenges to the anaesthetist due to neonatal anatomy and physiology that is very different from that in children and adults. These challenges increase when the neonate is premature, but also if they have associated co-morbidities. There are certain medical conditions that exclusively affect neonates, or that affects neonates more commonly and significantly. When they present for anaesthesia and surgery, it is essential that the anaesthetist understands the implications of these co-morbid problems. A multidisciplinary approach involving neonatologists and other sub-specialists should be sought to ensure safe perioperative management of the ongoing medical issue. This article aims to address some common medical diagnoses and considerations for safe anaesthesia in these babies.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 11","pages":"Pages 768-773"},"PeriodicalIF":0.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528133","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.2025.10.008
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}
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