Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.004
Chris KH Li, Jane C Ko
Hypersensitivity reactions are rare yet significant perioperative complications. Prompt referral of patients with previous perioperative hypersensitivity to the immunology service aids in the identification of the culprit agent and safe alternatives for future anaesthetics. Both in-vivo and in-vitro tests exist for the evaluation of perioperative hypersensitivity. Serum tryptase sampling is utilized to confirm the diagnosis of perioperative hypersensitivity reactions together with clinical history. Skin testing is the first-line investigation due to its well established profile. In-vitro tests such as specific immunoglobulin E quantification and basophil activation test have the advantage of sparing the patient from re-exposure. Drug provocation tests remain to be the gold standard yet require careful patient selection and closely collaborated anaesthetist–immunologist care in the perioperative setting.
{"title":"Perioperative allergy testing","authors":"Chris KH Li, Jane C Ko","doi":"10.1016/j.mpaic.2025.07.004","DOIUrl":"10.1016/j.mpaic.2025.07.004","url":null,"abstract":"<div><div>Hypersensitivity reactions are rare yet significant perioperative complications. Prompt referral of patients with previous perioperative hypersensitivity to the immunology service aids in the identification of the culprit agent and safe alternatives for future anaesthetics. Both in-vivo and in-vitro tests exist for the evaluation of perioperative hypersensitivity. Serum tryptase sampling is utilized to confirm the diagnosis of perioperative hypersensitivity reactions together with clinical history. Skin testing is the first-line investigation due to its well established profile. In-vitro tests such as specific immunoglobulin E quantification and basophil activation test have the advantage of sparing the patient from re-exposure. Drug provocation tests remain to be the gold standard yet require careful patient selection and closely collaborated anaesthetist–immunologist care in the perioperative setting.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 559-565"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050351","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 : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.005
Christina T.Y. Cheung, Eva Y.F. Chan
Postoperative pulmonary complications are common. Despite advances in perioperative care for patients undergoing major surgery, they are associated with increased morbidity, mortality and healthcare costs. Strategies to reduce postoperative pulmonary complications include identification of patients at risk for respiratory complications, followed by risk stratification and perioperative optimization. This article evaluates current literature on the definition of postoperative pulmonary complications, their underlying biological mechanisms, contributing risk factors and preventative measures. Of note, the wide variability in the definition of postoperative pulmonary complications highlights the importance of identifying outcome measures and standardized end points as they affect the validity of clinical trials. Validated risk prediction models are useful tools for clinicians to stratify patients at risk, however there is still a lack of consensus over which model is the best one to use. Evidence for preventative measures including smoking cessation, correction of anaemia, perioperative respiratory physiotherapy and intraoperative management including lung-protective ventilation and goal-directed haemodynamic therapy are discussed. Most importantly, perioperative care bundles demonstrate the importance of multidisciplinary involvement during different time points when a patient undergoes surgery, and a combination of interventions are found to be more beneficial than individual interventions alone.
{"title":"Postoperative pulmonary complications and their prevention","authors":"Christina T.Y. Cheung, Eva Y.F. Chan","doi":"10.1016/j.mpaic.2025.07.005","DOIUrl":"10.1016/j.mpaic.2025.07.005","url":null,"abstract":"<div><div>Postoperative pulmonary complications are common. Despite advances in perioperative care for patients undergoing major surgery, they are associated with increased morbidity, mortality and healthcare costs. Strategies to reduce postoperative pulmonary complications include identification of patients at risk for respiratory complications, followed by risk stratification and perioperative optimization. This article evaluates current literature on the definition of postoperative pulmonary complications, their underlying biological mechanisms, contributing risk factors and preventative measures. Of note, the wide variability in the definition of postoperative pulmonary complications highlights the importance of identifying outcome measures and standardized end points as they affect the validity of clinical trials. Validated risk prediction models are useful tools for clinicians to stratify patients at risk, however there is still a lack of consensus over which model is the best one to use. Evidence for preventative measures including smoking cessation, correction of anaemia, perioperative respiratory physiotherapy and intraoperative management including lung-protective ventilation and goal-directed haemodynamic therapy are discussed. Most importantly, perioperative care bundles demonstrate the importance of multidisciplinary involvement during different time points when a patient undergoes surgery, and a combination of interventions are found to be more beneficial than individual interventions alone.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 566-573"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050247","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 : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.011
Craig Urquhart, Fiona Preston
With an ageing population, the need to provide safe anaesthesia and intensive care for increasingly complex surgeries in elderly patients has become a priority. Older patients often have significant comorbidities and, therefore, experience much higher morbidity and mortality rates compared to younger adults. This discussion will explore the physiological and anatomical changes associated with ageing and how these may affect anaesthesia techniques and choices. Additionally, we will address perioperative risks in the elderly, emphasizing emergency surgery and optimizing outcomes.
{"title":"Physiology of the elderly","authors":"Craig Urquhart, Fiona Preston","doi":"10.1016/j.mpaic.2025.07.011","DOIUrl":"10.1016/j.mpaic.2025.07.011","url":null,"abstract":"<div><div>With an ageing population, the need to provide safe anaesthesia and intensive care for increasingly complex surgeries in elderly patients has become a priority. Older patients often have significant comorbidities and, therefore, experience much higher morbidity and mortality rates compared to younger adults. This discussion will explore the physiological and anatomical changes associated with ageing and how these may affect anaesthesia techniques and choices. Additionally, we will address perioperative risks in the elderly, emphasizing emergency surgery and optimizing outcomes.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 599-604"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050253","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 : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.002
Yuet Wong, Aaron KH Lee
Postoperative neurocognitive disorders (NCDs) are common perioperative complications observed in elderly patients after undergoing either elective and emergency surgeries. They pose a great challenge to patient's health, medical professionals and the public health system as they cause increased patient morbidity, mortality, decreased patient quality of life and increased medical costs. In this article, we explore the basic science, definitions, prevalence and diagnosis of postoperative NCDs, as well as their pathogenesis, risk factors, perioperative preventive measures and possible treatment modalities.
{"title":"Perioperative brain health and postoperative neurocognitive disorders","authors":"Yuet Wong, Aaron KH Lee","doi":"10.1016/j.mpaic.2025.07.002","DOIUrl":"10.1016/j.mpaic.2025.07.002","url":null,"abstract":"<div><div>Postoperative neurocognitive disorders (NCDs) are common perioperative complications observed in elderly patients after undergoing either elective and emergency surgeries. They pose a great challenge to patient's health, medical professionals and the public health system as they cause increased patient morbidity, mortality, decreased patient quality of life and increased medical costs. In this article, we explore the basic science, definitions, prevalence and diagnosis of postoperative NCDs, as well as their pathogenesis, risk factors, perioperative preventive measures and possible treatment modalities.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 543-547"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050349","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 : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.001
Joseph McGeary, Ellen P O'Sullivan
Tracheal intubation is the process of inserting a breathing tube into the trachea to provide airway patency and is primarily used to facilitate ventilation for the provision of surgery and critical care. It is the gold standard in airway protection from gastric aspiration or soiling from oropharyngeal secretions. With appropriate assessment and preparation, the vast majority of tracheal intubations are safe and uneventful, however patients can present with anatomical and physiological variations creating a difficult airway scenario. It is therefore of the highest importance that anaesthetists and airway management teams are familiar with the signs of a potentially difficult airway and are appropriately trained in the application of equipment that can increase the chance of a first attempt intubation.
{"title":"Tracheal intubation","authors":"Joseph McGeary, Ellen P O'Sullivan","doi":"10.1016/j.mpaic.2025.07.001","DOIUrl":"10.1016/j.mpaic.2025.07.001","url":null,"abstract":"<div><div>Tracheal intubation is the process of inserting a breathing tube into the trachea to provide airway patency and is primarily used to facilitate ventilation for the provision of surgery and critical care. It is the gold standard in airway protection from gastric aspiration or soiling from oropharyngeal secretions. With appropriate assessment and preparation, the vast majority of tracheal intubations are safe and uneventful, however patients can present with anatomical and physiological variations creating a difficult airway scenario. It is therefore of the highest importance that anaesthetists and airway management teams are familiar with the signs of a potentially difficult airway and are appropriately trained in the application of equipment that can increase the chance of a first attempt intubation.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 535-542"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050570","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 : 2025-07-17DOI: 10.1016/j.mpaic.2025.06.001
Vijayanand Nadella
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.06.001","DOIUrl":"10.1016/j.mpaic.2025.06.001","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 532-533"},"PeriodicalIF":0.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723694","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 : 2025-07-17DOI: 10.1016/j.mpaic.2025.05.007
Nora Gonzalez, Andrew Mackay
Poisoning is a common reason for admission to the intensive care unit. Most cases are due to deliberate self-harm with common poisons; however, there are occasional unusual poisons which require more detailed assessment. Patients are often obtunded or unwilling to co-operate so a knowledge of toxidromes can help to identify symptoms that are related to a particular group of drugs, and therefore influence management. The management of poisoned patients is generally supportive, including measures to reduce absorption and increase elimination, but can also include the use of specific antidotes and techniques to remove poisons.
{"title":"The poisoned patient","authors":"Nora Gonzalez, Andrew Mackay","doi":"10.1016/j.mpaic.2025.05.007","DOIUrl":"10.1016/j.mpaic.2025.05.007","url":null,"abstract":"<div><div>Poisoning is a common reason for admission to the intensive care unit. Most cases are due to deliberate self-harm with common poisons; however, there are occasional unusual poisons which require more detailed assessment. Patients are often obtunded or unwilling to co-operate so a knowledge of toxidromes can help to identify symptoms that are related to a particular group of drugs, and therefore influence management. The management of poisoned patients is generally supportive, including measures to reduce absorption and increase elimination, but can also include the use of specific antidotes and techniques to remove poisons.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 486-490"},"PeriodicalIF":0.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723692","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 : 2025-07-09DOI: 10.1016/j.mpaic.2025.05.011
Brooke Riley, Julia Coull, Søren Aalbæk Madsen
Extracorporeal membrane oxygenation (ECMO) support of the respiratory system has undergone significant evolution over the past decade. Historically used as rescue therapy, the treatment is now being utilized earlier in the disease course, and its indications for use expanded. The coronavirus disease (COVID-19) pandemic has further increased the experience of ECMO centres and expanded the body of evidence. This article will review the physiology of veno-venous (VV) ECMO, control of oxygenation and carbon dioxide, principal equipment, patient selection and timing, complications and weaning from VV ECMO.
{"title":"Extracorporeal support of the respiratory system","authors":"Brooke Riley, Julia Coull, Søren Aalbæk Madsen","doi":"10.1016/j.mpaic.2025.05.011","DOIUrl":"10.1016/j.mpaic.2025.05.011","url":null,"abstract":"<div><div>Extracorporeal membrane oxygenation (ECMO) support of the respiratory system has undergone significant evolution over the past decade. Historically used as rescue therapy, the treatment is now being utilized earlier in the disease course, and its indications for use expanded. The coronavirus disease (COVID-19) pandemic has further increased the experience of ECMO centres and expanded the body of evidence. This article will review the physiology of veno-venous (VV) ECMO, control of oxygenation and carbon dioxide, principal equipment, patient selection and timing, complications and weaning from VV ECMO.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 523-527"},"PeriodicalIF":0.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723688","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 : 2025-07-08DOI: 10.1016/j.mpaic.2025.05.003
Freddie Hopkinson, Ryan Hughes, Matthew J Brain
Stewart's quantitative physicochemical model of human acid-base physiology filled a void between clinical acid–base analysis and general fluid physiology. The physicochemical model is frequently perceived as too complex for bedside use, however a set of simplified screening questions based on Stewart's model can be utilized to aid acid–base interpretation. Emphasis is placed on understanding the acid–base consequences of hypoalbuminaemia, volume status, tonicity and chloride as these are common in intensive care unit patients.
{"title":"Strong ion analysis at the bedside","authors":"Freddie Hopkinson, Ryan Hughes, Matthew J Brain","doi":"10.1016/j.mpaic.2025.05.003","DOIUrl":"10.1016/j.mpaic.2025.05.003","url":null,"abstract":"<div><div>Stewart's quantitative physicochemical model of human acid-base physiology filled a void between clinical acid–base analysis and general fluid physiology. The physicochemical model is frequently perceived as too complex for bedside use, however a set of simplified screening questions based on Stewart's model can be utilized to aid acid–base interpretation. Emphasis is placed on understanding the acid–base consequences of hypoalbuminaemia, volume status, tonicity and chloride as these are common in intensive care unit patients.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 477-485"},"PeriodicalIF":0.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721094","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 : 2025-07-07DOI: 10.1016/j.mpaic.2025.05.014
Li Theng Novia Tan, Sarah Ann Yong
Mechanical ventilation is a crucial supportive intervention that allows time to facilitate investigations and provides definitive treatment in critically ill patients. This article focuses on the various modes of respiratory support available, and the mechanical ventilation strategies used in specific disease processes. It also highlights possible complications associated with mechanical ventilation and adjuncts that can be used to aid oxygenation.
{"title":"Ventilatory support in the intensive care unit","authors":"Li Theng Novia Tan, Sarah Ann Yong","doi":"10.1016/j.mpaic.2025.05.014","DOIUrl":"10.1016/j.mpaic.2025.05.014","url":null,"abstract":"<div><div>Mechanical ventilation is a crucial supportive intervention that allows time to facilitate investigations and provides definitive treatment in critically ill patients. This article focuses on the various modes of respiratory support available, and the mechanical ventilation strategies used in specific disease processes. It also highlights possible complications associated with mechanical ventilation and adjuncts that can be used to aid oxygenation.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 8","pages":"Pages 498-506"},"PeriodicalIF":0.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723784","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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