Anaesthesia and Intensive Care Medicine最新文献

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Ion channels, receptors, agonists and antagonists 离子通道，受体，激动剂和拮抗剂

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 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 (GABA_A) receptors) ligand-gated ion channels that constitute targets for a variety of drugs including examples used in anaesthesia and intensive care medicine.

受体和离子通道是麻醉和重症监护医学常用药物的关键靶点，药物作为激动剂、拮抗剂或逆激动剂与靶点相互作用，发挥其生理作用。本文介绍了药物亲和力、功效和效价的基本概念，以及这些原则与选定药物的作用机制的关系。描述了细胞内受体、核受体和g蛋白偶联受体（gpcr）的药物受体相互作用，包括对受体结构的讨论和控制细胞功能的细胞内信号通路的例子。本文还探讨了电压门控和配体门控离子通道，并讨论了这些离子通道的活性如何受膜电位变化的控制。除了主要的兴奋性（如n -甲基- d-天冬氨酸（NMDA）受体）和抑制性（如γ-氨基丁酸A （GABAA）受体）配体门控离子通道外，还讨论了电压门控钠、钾和钙离子通道，这些离子通道构成了各种药物的靶标，包括麻醉和重症监护医学中使用的例子。

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引用次数: 0

Anaesthesia in the MRI unit MRI病房麻醉

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 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.

磁共振成像（MRI）是一种广泛使用的成像方式，提供高分辨率的软组织图像。这些扫描仪产生的磁场带来了一系列安全挑战，需要专业设备和训练有素的工作人员在这种环境下安全操作。尽管对许多人来说，这仍然是一个不太熟悉的环境和偏远的地方，但在MR套件中工作的麻醉师可以获得指导。我们概述了常见植入设备的具体问题，以及在MRI套件中照顾这些设备的患者的一些实用性。在神经麻醉领域，核磁共振成像技术的进步导致越来越多的患者需要扫描诊断和治疗进展。这包括在重症监护病房和手术中在介入MRI套房的患者。

引用次数: 0

Anaesthesia for neurointerventional radiology 神经介入放射学麻醉

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.010

Lalithaa Rhaasa, Smita Bapat

Neurointerventional radiology (NIR) for the diagnosis and treatment of neurological conditions has undergone significant advances. The scope of disease amenable to endovascular therapy continues to expand, with pathology previously requiring open surgery, now managed in the NIR suite. Anaesthetists will become more involved in providing care for these patients, in particular those with acute ischaemic stroke (AIS), since incidence is increasing, and access to mechanical thrombectomy (MT) services is a priority in the NHS Long Term Plan. NIR procedures can be complex and lengthy, and close liaison between the radiology, neurosurgical, stroke and anaesthesia teams is vital. To underpin this, a good understanding of the environment, procedures and their physiological effects as well as the anaesthetic implications is also required. Close monitoring for complications both during and following the procedure is necessary to promptly recognize and treat these, either via further radiological treatment or by surgery.

神经介入放射学（NIR）在诊断和治疗神经系统疾病方面取得了重大进展。适合血管内治疗的疾病范围继续扩大，以前的病理需要开放手术，现在在NIR套件中进行管理。麻醉师将更多地参与为这些患者提供护理，特别是急性缺血性卒中（AIS）患者，因为发病率正在增加，并且获得机械取栓（MT）服务是NHS长期计划的优先事项。近红外过程可能复杂而漫长，放射学、神经外科、中风和麻醉团队之间的密切联系至关重要。为了支持这一点，还需要对环境，程序及其生理影响以及麻醉影响有很好的了解。在手术期间和手术后密切监测并发症是必要的，以便通过进一步的放射治疗或手术及时识别和治疗这些并发症。

引用次数: 0

Pharmacological and pathological modulation of cerebral physiology 脑生理学的药理和病理调节

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.012

Daniel Ball, Katharine Hunt

Homeostatic mechanisms exist to enable the supply of oxygen and glucose for cerebral metabolism and neuronal function. In health, cerebral autoregulation, neurogenic and metabolic processes ensure that the supply of these nutrients is adequate to meet metabolic requirements, thus preventing neuronal cell damage. The goals of neuro-anaesthesia are to provide optimal operating conditions and provide adequate cerebral blood flow, often in the context of a vulnerable brain which is exposed to the physiological stress of surgical trauma. This article outlines how delivery of anaesthesia and disease processes affecting the brain modulate the mechanisms that regulate cerebral blood flow and metabolism.

体内平衡机制的存在使大脑代谢和神经元功能所需的氧气和葡萄糖得以供应。在健康状态下，大脑自身调节、神经源性和代谢过程确保这些营养物质的供应足以满足代谢需求，从而防止神经元细胞损伤。神经麻醉的目标是提供最佳的手术条件和充足的脑血流量，通常是在易受手术创伤生理应激的大脑的情况下。本文概述了麻醉的输送和影响大脑的疾病过程如何调节调节脑血流量和代谢的机制。

引用次数: 0

Targeted temperature management in acute brain injury 急性脑损伤的目标温度管理

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.008

Arjun Joshi, Mark Earl

Fever is a common complication in adults with acute brain injury and has consistently been associated with worse neurological outcomes and increased mortality. Whilst acute brain injury comprises a heterogenous group of pathologies, the need to mitigate against secondary brain injury is a unifying principle in their management, and targeted temperature control is a key component of a multi-modal neuroprotective strategy.

The contemporary approach to temperature management within neurocritical care focuses on avoiding hyperthermia, maintaining normothermia and, in some cases, inducing hypothermia. Recent expert consensus guidance support the use of targeted temperature management with an emphasis on timely initiation, limitation of temperature variability, and avoidance of hyperthermia for the period of risk of secondary brain injury.

In this article we aim to summarize the evidence for each of the key brain pathologies for which targeted temperature management is undertaken and provide an overview of the practical aspects involved in successfully delivering high-quality temperature control.

发烧是急性脑损伤成人的常见并发症，一直与更差的神经预后和更高的死亡率相关。虽然急性脑损伤包括异质性病理，但减轻继发性脑损伤的需要是其管理的统一原则，而有针对性的温度控制是多模式神经保护策略的关键组成部分。在神经危重症护理中，当前的温度管理方法侧重于避免高热，维持体温正常，在某些情况下，诱导低温。最近的专家共识指导支持使用有针对性的温度管理，重点是及时启动，限制温度变化，并避免在继发性脑损伤风险期间使用热疗。在这篇文章中，我们的目标是总结每一个关键的脑病的证据，有针对性的温度管理进行，并提供了成功提供高质量的温度控制涉及的实际方面的概述。

引用次数: 0

Anaesthesia for neurosurgery: an update 神经外科麻醉：最新进展

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.002

Keisher Hoyte, Zainab Hussein, Astri MV Luoma

Neurosurgery is a dynamic field encompassing a wide range of procedures involving the cranium and spinal cord, alongside rapidly advancing subspecialist areas such as awake craniotomy, interventional neuroradiology, functional neurosurgery, and intraoperative magnetic resonance imaging (iMRI). To support these complex procedures and deliver high-quality perioperative care, the neuroanaesthetist must have a comprehensive understanding of neurophysiology and the pathophysiology of underlying neurological conditions. This review article provides an update to a previously published paper.

神经外科是一个充满活力的领域，涵盖了涉及颅骨和脊髓的广泛手术，以及快速发展的亚专科领域，如清醒开颅术、介入神经放射学、功能神经外科和术中磁共振成像（iMRI）。为了支持这些复杂的手术并提供高质量的围手术期护理，神经麻醉师必须对神经生理学和潜在神经系统疾病的病理生理学有全面的了解。这篇综述文章是对先前发表的一篇论文的更新。

引用次数: 0

Intensive care management of encephalitis 脑炎的重症监护管理

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.001

N Thambirajah, J Spillane, C.F. Houlihan, R Howard

Encephalitis is a medical emergency caused by infections or autoimmune disorders. It is characterized by altered mental status with additional features of brain inflammation. New-onset seizures and neurological deficits may be present. Changes in MRI brain and electroencephalography are often seen. With infectious causes, fevers, headache and cerebrospinal fluid leucocytosis are more common. Clinical presentation may vary in immunocompromised individuals. Autoimmune presentations tend to be more subacute, and preceding fevers, a high CSF leucocyte count and protein are less common. A lumbar puncture should be carried out as soon as possible if there are no contraindications and antivirals should be instituted without delay. Patients may also have reduced levels of consciousness, have cardiorespiratory compromise, refractory seizures and have features of raised intracranial pressure needing intensive care management. A focused but thorough approach is needed. This article aims to provide such an outline.

脑炎是一种由感染或自身免疫性疾病引起的医学紧急情况。它的特点是精神状态改变，并伴有脑部炎症的附加特征。可能出现新发癫痫和神经功能障碍。MRI脑及脑电图常见改变。在感染性疾病中，发热、头痛和脑脊液白细胞增多更为常见。免疫功能低下个体的临床表现可能有所不同。自身免疫表现往往是亚急性的，在发烧之前，脑脊液白细胞计数和蛋白含量高是不常见的。如果没有禁忌症，应尽快进行腰椎穿刺，并应立即制定抗病毒药物。患者也可能意识水平下降，心肺功能受损，难治性癫痫发作，并有颅内压升高的特征，需要重症监护管理。需要一种集中但彻底的方法。本文旨在提供这样一个大纲。

引用次数: 0

A clinical approach to coma: neurological assessment of the comatose patient 昏迷的临床方法：昏迷患者的神经学评估

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.014

Gerry Christofi

Coma is a state marked by the absence of arousal (wakefulness, vigilance) and awareness of one's self and environment. Patients in coma do not respond to internal or external stimuli and cannot be roused. Coma results from diffuse dysfunction of neuronal systems that govern awareness and arousal, and is a neurological emergency. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and rarely psychiatric causes. Firstly, the patient should be stabilized by treating life-threatening conditions. Diagnostic and therapeutic steps should occur simultaneously. The history, physical examination and investigation results should be used to identify structural causes and diagnose treatable conditions. In many instances, the diagnosis is clear. Adoption of a systematic approach, based on the underlying principles of coma pathophysiology, combined with knowledge of the reversible causes increases the probability of establishing an early diagnosis. Patients not undergoing brain imaging should be regularly re-assessed. If CT imaging is unrevealing, then consideration should be given to advanced imaging and looking for evidence of treatable infection or poisoning, seizures including non-convulsive status epilepticus, endocrine disorders or thiamine deficiency.

昏迷是一种以缺乏觉醒（清醒、警觉）和对自我和环境的意识为特征的状态。昏迷的病人对内外刺激没有反应，不能被唤醒。昏迷是控制意识和觉醒的神经系统弥漫性功能障碍的结果，是一种神经急症。昏迷的三种主要机制是结构性脑损伤、弥漫性神经元功能障碍，很少有精神原因。首先，应该通过治疗危及生命的疾病来稳定患者。诊断和治疗步骤应同时进行。病史、体格检查和调查结果应用于确定结构性原因和诊断可治疗的疾病。在许多情况下，诊断是明确的。采用系统的方法，基于昏迷病理生理学的基本原理，结合可逆原因的知识，增加了建立早期诊断的可能性。未接受脑成像的患者应定期重新评估。如果CT图像未显示，则应考虑进行高级影像学检查，寻找可治疗的感染或中毒、癫痫发作（包括非惊厥性癫痫持续状态）、内分泌紊乱或硫胺素缺乏的证据。

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引用次数: 0

Self-assessment 自我评估

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.013

Vijayanand Nadella

引用次数: 0

Principles of intraoperative neurophysiological monitoring and anaesthetic considerations 术中神经生理监测原则及麻醉注意事项

IF 0.3 Q4 ANESTHESIOLOGY

Anaesthesia and Intensive Care Medicine

Pub Date : 2025-10-01 DOI: 10.1016/j.mpaic.2025.08.005

Brett Sanders, Santiago Catania, Astri MV. Luoma

Surgery to the nervous system poses risks to neural structures be that mechanical, haemodynamical, chemical or thermal. The role of intraoperative neurophysiological monitoring (IONM) is to facilitate the assessment of the functional integrity of neural structures and provide a real-time alerting system when changes caused by surgically induced insults are detected, with the goal of reducing the risk of postoperative neurological deficits. Furthermore, it is also used as a guidance system to map eloquent areas within the cortex and to identify specific neuronal structures, particularly when landmarks cannot be easily recognized. In this article, we focus on the various neurophysiological modalities used in intraoperative monitoring, their basic principles, indications and the information that they provide. We also examine the anaesthetic considerations and the checklist for the multidisciplinary team should an intraoperative alert be issued.

神经系统手术对神经结构造成的风险包括机械的、血流动力学的、化学的或热的。术中神经生理监测（IONM）的作用是便于评估神经结构的功能完整性，并在检测到手术损伤引起的变化时提供实时警报系统，目的是降低术后神经功能缺损的风险。此外，它还被用作引导系统，用于绘制大脑皮层中有意义的区域，并识别特定的神经元结构，尤其是在地标不容易识别的情况下。在本文中，我们重点介绍了术中监测中使用的各种神经生理模式，它们的基本原理，适应症和它们提供的信息。我们还检查了麻醉的考虑因素和多学科小组的检查表，以防术中警报发出。

引用次数: 0

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