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Safeguarding for anaesthetists: working to protect children 麻醉师的保障:努力保护儿童
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.009
Siaelda Green, Arun Ghose

Safeguarding is an action that promotes the welfare of children and adults and aims to protect them from harm and maltreatment. This article will focus on children and the role of the anaesthetist. As an anaesthetist, you may not see signs of abuse often, but you will see children in different settings and should be able to clearly communicate any worrying concerns. Reading this article will increase your knowledge of laws and statutory advice for safeguarding.

保护是一种促进儿童和成人福利的行动,旨在保护他们免受伤害和虐待。本文将重点关注儿童和麻醉师的角色。作为一名麻醉师,您可能不会经常看到虐待的迹象,但您会在不同的环境中看到儿童,并应能够清楚地传达任何令人担忧的问题。阅读这篇文章将增加您对法律和法定保障建议的了解。
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引用次数: 0
Developmental pharmacology 发育药理学
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.004
Graeme Wilson

Growth and maturation characterize the transition of neonates to adults. The physiological changes that children undergo present numerous pharmacological conundrums for the anaesthetist. Extensive changes in drug absorption, protein binding, metabolism and excretion during development result in wide variability in drug disposition. Pharmacodynamic differences and genetic polymorphisms further exacerbate these pharmacokinetic disparities. These changes directly affect drug efficacy and toxicity, and an awareness of this is crucial for clinicians involved in paediatric anaesthesia. Population-based pharmacokinetic–pharmacodynamic modelling provides a novel prospect in paediatric pharmacology research. Modelling has the potential to improve safety in clinical trials and enhance our understanding of drug disposition in vulnerable populations like preterm neonates. Although progress is occurring in developmental pharmacology, gaps remain, and a lot yet remains to be elucidated.

生长和成熟是新生儿向成人过渡的特征。儿童所经历的生理变化给麻醉师带来了许多药理学难题。在发育过程中,药物的吸收、蛋白结合、代谢和排泄发生了广泛的变化,导致药物的处置存在很大差异。药效学差异和基因多态性进一步加剧了这些药效学差异。这些变化直接影响到药物的疗效和毒性,因此了解这一点对于从事儿科麻醉的临床医生来说至关重要。基于人群的药代动力学-药效学建模为儿科药理学研究提供了新的前景。建模有可能提高临床试验的安全性,并加深我们对早产新生儿等易感人群药物处置的了解。尽管发育药理学正在取得进展,但差距依然存在,还有许多问题有待阐明。
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引用次数: 0
Induction of anaesthesia 麻醉诱导
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.006
Jillian Scott, Brian Lafferty, Robert Hart

General anaesthesia is a state of controlled unconsciousness utilized to perform a therapeutic procedure. The aims of anaesthesia have traditionally been summarized by the triad of hypnosis, analgesia and muscle relaxation. The process begins with preoperative assessment of the patient before ensuring equipment and drugs are available and safe to use. Anaesthesia commences with administration of induction agents, delivered via inhalational or intravenous routes. Consideration of airway management is an essential component of the induction phase of anaesthesia. The choice and dose of induction agent is multifactorial and can include: co-morbidity; type of surgery, age and patient physiology. Following induction of anaesthesia, the maintenance phase of anaesthesia can be delivered via an inhalation or intravenous route. The administration of anaesthetic drugs is generally associated with rapid loss of airway reflexes and cardiorespiratory changes. Complications of general anaesthesia can include awareness, aspiration, anaphylaxis, airway loss, laryngospasm, cardiovascular instability, malignant hyperpyrexia and dental damage. Meticulous attention to detail is vital to minimize the risk of these potential complications.

全身麻醉是一种为实施治疗程序而控制的无意识状态。麻醉的目的历来被概括为催眠、镇痛和肌肉放松三要素。在确保设备和药物齐备且可安全使用之前,首先要对患者进行术前评估。通过吸入或静脉途径给予诱导剂后开始麻醉。考虑气道管理是麻醉诱导阶段的重要组成部分。诱导剂的选择和剂量受多种因素影响,其中包括:并发症、手术类型、年龄和患者体质。麻醉诱导后,麻醉维持阶段可通过吸入或静脉途径进行。麻醉药物的使用通常会导致气道反射的迅速消失和心肺功能的改变。全身麻醉的并发症包括意识丧失、吸入、过敏性休克、气道缺失、喉痉挛、心血管不稳定、恶性高热和牙齿损伤。要将这些潜在并发症的风险降至最低,对细节的一丝不苟至关重要。
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引用次数: 0
Humidification devices 加湿装置
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.008
Stuart Gaffney, Andrew Dalton

Humidification is concerned with the addition of water vapour to a gas and can be measured as either absolute or relative. Adequate humidification is a vital consideration in anaesthesia given that the anatomical source of natural gas humidification (the nasopharynx) is generally bypassed, which can lead to complications including hypothermia, thickening of respiratory secretions, mucus plugging and airway keratinization. Humidification may be passive or active. Equipment involved in passive humidification includes heat and moisture exchanger (HME) filters, soda lime and cold water baths, with these devices able to achieve varying efficiencies without extrinsic energy input. Active humidification devices (including hot water baths) are capable of delivering a higher relative humidity but are associated with higher cost and potential hazards. While not strictly classed as true humidification devices, nebulizers are considered in this article as they add water droplets into a gas flow using a Venturi system, spinning discs or ultrasound vibration technology.

加湿是指在气体中加入水蒸气,可以用绝对湿度或相对湿度来衡量。在麻醉过程中,充分的加湿是一个重要的考虑因素,因为自然气体加湿的解剖源(鼻咽部)通常会被绕过,这可能会导致低体温、呼吸道分泌物变稠、粘液堵塞和气道角质化等并发症。加湿可以是被动的,也可以是主动的。被动加湿设备包括热湿交换器(HME)过滤器、苏打石灰和冷水浴,这些设备在没有外来能源输入的情况下可以达到不同的效率。主动加湿装置(包括热水浴)能够提供较高的相对湿度,但成本较高,而且存在潜在危险。雾化器严格来说并不属于真正的加湿设备,但本文也考虑使用雾化器,因为雾化器通过文丘里系统、旋转盘或超声波振动技术将水滴加入气流中。
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引用次数: 0
Associated medical conditions in children 儿童的相关病症
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.06.001
Raymond Kelly, Caoimhe Casby

Children with acute and chronic associated medical conditions often present for surgical and radiological procedures. An understanding of the implications of these conditions for anaesthesia is important for preventing perioperative adverse events. In this article, we outline the relevant clinical features of some of the commonly encountered associated medical conditions and provide guidance on the current evidence for the perioperative anaesthetic management of these children.

患有急性和慢性相关疾病的儿童经常需要接受外科手术和放射治疗。了解这些疾病对麻醉的影响对于预防围术期不良事件非常重要。在本文中,我们将概述一些常见相关疾病的相关临床特征,并就这些儿童围术期麻醉管理的现有证据提供指导。
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引用次数: 0
Self-assessment 自我评估
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.011
Vijayanand Nadella
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引用次数: 0
Equipment and monitoring in paediatric anaesthesia 儿科麻醉的设备和监测
IF 0.2 Q4 ANESTHESIOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.mpaic.2024.05.003
Dannie Seddon, Monique McLeod

Advances in paediatric anaesthetic equipment and monitoring continue to be made. While the mainstay of airway intubating equipment currently is the direct laryngoscope, videolaryngoscopes and endoscopes are increasing in their use. These continue to evolve, generating better quality pictures, with more sophisticated yet easier to use equipment. Vascular access in paediatric anaesthesia can be challenging. Ultrasound has become an integral piece of equipment in the management of these children with difficult access. As the population increases in weight, so the management of the obese child is now a reality. This requires thought and careful planning of their perioperative care. Newer techniques such as high flow nasal oxygen are useful both to prevent hypoxia at induction, but also to facilitate surgery. Total intravenous anaesthesia will be discussed with reference to paediatric algorithms and equipment. Neurological monitoring in the form of near-infrared spectroscopy and depth of anaesthesia monitoring are discussed with evidence relevant to paediatric practice.

儿科麻醉设备和监护技术不断进步。虽然目前气道插管设备的主流是直接喉镜,但视频喉镜和内窥镜的使用也在不断增加。这些设备不断发展,图像质量更高,设备更先进但使用更简便。儿科麻醉中的血管通路具有挑战性。超声已成为管理这些难以进入血管的儿童不可或缺的设备。随着人口体重的增加,肥胖儿童的管理已成为现实。这就需要对他们的围手术期护理进行深思熟虑和精心策划。高流量鼻氧等新技术不仅可以防止诱导时的缺氧,还能促进手术的进行。全静脉麻醉将参照儿科的算法和设备进行讨论。讨论了近红外光谱形式的神经监测和麻醉深度监测,并提供了与儿科实践相关的证据。
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引用次数: 0
Resource allocation in intensive care 重症监护的资源分配
IF 0.3 Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.mpaic.2024.03.016
Paul H. Purvis, Paul C. McConnell

Intensive care medicine has higher per-patient costs, staffing ratios and intervention rates than many other healthcare settings. Besides the economic impact, treatment is burdensome; the decision to admit patients to the intensive care unit must be carefully balanced against the prospect of meaningful recovery. With advances in medicine and surgery, a higher proportion of increasingly comorbid patients with advanced age are presenting to intensive care. Even in developed countries, resources remain limited, and clinicians must carefully consider to whom these resources are allocated in order to maximize benefit. Resource scarcity during the recent coronavirus disease pandemic presented further challenges. Classical ethical principles can be interwoven with newer models of ethical decision-making to help the intensive care team maximize the utility of available resources.

与许多其他医疗机构相比,重症监护医学的人均成本、人员配备比和干预率都更高。除了经济影响之外,治疗也是一种负担;在决定是否将病人送入重症监护病房时,必须仔细权衡病人是否能得到有效康复。随着医学和外科手术的进步,越来越多的高龄合并症患者被送入重症监护室。即使在发达国家,资源也是有限的,临床医生必须仔细考虑将这些资源分配给谁,以获得最大收益。在最近冠状病毒疾病大流行期间,资源匮乏带来了更多挑战。传统的伦理原则可以与较新的伦理决策模式相结合,帮助重症监护团队最大限度地利用现有资源。
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引用次数: 0
Anaesthesia for renal transplantation 肾移植手术麻醉
IF 0.3 Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.mpaic.2024.03.018
Sarah Meredith, Aravind Basavaraju, Neil Logan

Renal transplantation is the most common solid organ transplant performed and it is the treatment of choice for end-stage renal disease (ESRD). These patients present a unique set of challenges to the anaesthetist, who has a crucial role in the immediate success of the transplanted organ. This article describes the assessment of the adult patient for renal transplantation, the perioperative management and the aims in the postoperative period.

肾移植是最常见的实体器官移植手术,也是治疗终末期肾病(ESRD)的首选方法。这些患者对麻醉师提出了一系列独特的挑战,而麻醉师对移植器官的直接成功起着至关重要的作用。本文介绍了对成年肾移植患者的评估、围术期管理和术后目标。
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引用次数: 0
Anaesthesia and intensive care for adult liver transplantation 成人肝移植手术的麻醉和重症监护
IF 0.3 Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.mpaic.2024.03.013
Craig Beattie, Michael A. Gillies

This review describes the assessment and listing of the patient for liver transplantation and some of the perioperative challenges specific to this group of patients. The principles of the postoperative management in the intensive care unit are discussed as well as some of the signs of early graft dysfunction. Increasingly complex patients with advanced liver disease are receiving grafts from more marginal donors and this can present significant challenges to the transplant team. The anaesthetist and intensivist play a vital role in determining outcome in the perioperative period and must work collaboratively with surgeons and hepatologists to achieve the best patient outcomes.

这篇综述介绍了肝移植患者的评估和排序,以及这类患者围手术期的一些特殊挑战。文中还讨论了重症监护病房的术后管理原则,以及早期移植物功能障碍的一些征兆。越来越多病情复杂的晚期肝病患者接受了来自边缘供体的移植物,这给移植团队带来了巨大挑战。麻醉师和重症监护医师在决定围手术期的治疗效果方面发挥着至关重要的作用,他们必须与外科医生和肝病专家通力合作,以实现最佳的患者治疗效果。
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Anaesthesia and Intensive Care Medicine
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