{"title":"Ocular anatomy and physiology relevant to anaesthesia","authors":"Stuart Watson, Genevieve Lowe","doi":"10.1016/j.mpaic.2025.07.006","DOIUrl":"10.1016/j.mpaic.2025.07.006","url":null,"abstract":"<div><div>An understanding of the anatomy of the orbit is essential for performing regional anaesthesia for ophthalmic surgery. This article will discuss ocular anatomy in terms of the orbit and its contents, its associated muscles, nerves and blood supply, as well as basic ocular physiological principles.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 574-579"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050248","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}
{"title":"Regional anaesthesia for ophthalmic surgery","authors":"Craig S Urquhart, Rachel Fulton","doi":"10.1016/j.mpaic.2025.07.009","DOIUrl":"10.1016/j.mpaic.2025.07.009","url":null,"abstract":"<div><div>Most ophthalmic surgery is conducted under local anaesthetic (LA). The techniques range from topical anaesthetic drops to sharp needle regional blocks. The sub-Tenon's block is the most common regional technique in current practice superseding sharp needle techniques e.g. retrobulbar block. A sub-Tenon's block is a safe and effective means of providing analgesia, anaesthesia and good operating conditions.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 589-592"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050251","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}
{"title":"Anaesthesia for eye surgery in paediatrics","authors":"Katherine Maguire, Tom Y. Pettigrew","doi":"10.1016/j.mpaic.2025.07.008","DOIUrl":"10.1016/j.mpaic.2025.07.008","url":null,"abstract":"<div><div>In contrast to adult practice, the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may present with eye pathology as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child’s behaviour and medical comorbidities, taking into account the surgical conditions required for the intended procedure. Factors influencing intraocular pressure (IOP) may require careful manipulation, and anaesthetists should be vigilant of the oculocardiac reflex (OCR). Postoperative nausea and vomiting (PONV) is more common in ocular surgery, particularly following strabismus correction. In most cases, simple analgesics and intraoperative application of topical local anaesthesia are sufficient to provide effective postoperative pain relief.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 585-588"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050250","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}
{"title":"Neuromuscular function and transmission","authors":"Richard R. Ribchester, Thomas H. Gillingwater","doi":"10.1016/j.mpaic.2025.07.012","DOIUrl":"10.1016/j.mpaic.2025.07.012","url":null,"abstract":"<div><div>Understanding the biological processes and mechanisms underlying neuromuscular function in anaesthetized or sedated patients depends on adequate knowledge of the anatomy, physiology, and pathology of the connections between motor neurons and muscle fibres at neuromuscular junctions. Neuromuscular synaptic integrity depends on: maintenance of Ca<sup>2+</sup>-dependent release of acetylcholine by exocytosis from synaptic vesicles that fuse with active zones in motor nerve terminal membranes; the subsequent depolarizing action of acetylcholine on postsynaptic receptors at motor endplates; and termination of neuromuscular transmission by enzymic action of acetylcholinesterase located in the synaptic basal lamina. Homeostatic mechanisms sustain the magnitude of endplate potentials and the safety factor for neuromuscular transmission; but dysfunction of neuromuscular junctions occurs following administration of neuromuscular blockers or in diseases and other conditions affecting release, action and inactivation of acetylcholine.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 605-615"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050254","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}
{"title":"Care of the eye in anaesthesia","authors":"Jhalini Jawaheer, Emily Robertson","doi":"10.1016/j.mpaic.2025.07.010","DOIUrl":"10.1016/j.mpaic.2025.07.010","url":null,"abstract":"<div><div>This article describes care of the eye and the clinical signs that may indicate injury to the eye, relevant to the operating theatre and intensive care environments. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries are discussed, as are good practice points and preventative measures pertinent to anaesthetists. Signs of ocular infection, that intensivists should be vigilant for, are highlighted. Ocular injury in the trauma patient, that requires prompt evaluation and management of sight-threatening conditions, is also discussed.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 593-598"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050252","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}
{"title":"Data, information, knowledge, wisdom, and understanding","authors":"Jonathan E Dickerson","doi":"10.1016/j.mpaic.2025.07.013","DOIUrl":"10.1016/j.mpaic.2025.07.013","url":null,"abstract":"<div><div>The digital age commenced in the mid-20th century and since we have seen approximately exponential growth in information. This period has also seen the rapid growth of computer technology that has facilitated, for instance, the derivation of whole genomes and automated drug discovery. Data, information, knowledge and wisdom lay the foundations for understanding how experience is formed from evidence and observations. When data are put into context, the resultant information can drive growth and further contribute to increased knowledge. Appreciating the source of data enables us to recognize and hopefully correct for inherent error and bias. Ultimately knowledge discovery can be automated to gain information from data and so on, enhancing our understanding of a given subject and expanding collective wisdom.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 616-618"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050255","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}
{"title":"General anaesthesia for ophthalmic surgery","authors":"Stuart Young, Aravind Basavaraju","doi":"10.1016/j.mpaic.2025.07.007","DOIUrl":"10.1016/j.mpaic.2025.07.007","url":null,"abstract":"<div><div>The majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surgery. Therefore adequate preoperative evaluation and preparation will minimize perioperative complications. The goals of general anaesthesia are smooth induction and emergence, with stable intra-ocular pressure (IOP) and akinesia of the globe. These can be achieved with a combination of intravenous and inhalational agents with or without muscle relaxants and opiates. Use of the laryngeal mask airway has the advantage of causing a smaller rise in IOP on insertion and less coughing on emergence. Total intravenous anaesthesia with propofol and remifentanil has the advantages of causing less postoperative nausea and vomiting (PONV), reduced stress response to airway intervention, rapid recovery and smooth emergence. Some eye procedures require special consideration, for example, strabismus and vitreoretinal surgery involves traction of the rectus muscles producing a higher incidence of oculocardiac reflex and PONV. Most ophthalmic surgery produces mild to moderate pain amenable to non-opioid analgesics. Intraoperative topical and regional anaesthesia reduce postoperative pain and opiate requirement. Open globe injury and a full stomach present unique challenges to prevent increase in IOP as well as protecting the airway.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 580-584"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050249","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}
{"title":"Privacy, confidentiality, and security of healthcare information","authors":"Jonathan E Dickerson","doi":"10.1016/j.mpaic.2025.07.014","DOIUrl":"10.1016/j.mpaic.2025.07.014","url":null,"abstract":"<div><div>Patients must trust doctors, their decisions and actions; this confidence extends to how we treat patients’ information. Healthcare information should be accurate and securely stored in a readily accessible format. With the digital revolution it is increasingly simple to do this, but it is important to be mindful of just how easy it is to breach confidentiality. There is extensive legislation governing the use of healthcare information and the Caldicott principles describe good practice. All healthcare professions have a moral, ethical, regulatory and legal duty to be familiar with these and ensure adherence in daily practice.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 619-622"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050256","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}
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.07.015","DOIUrl":"10.1016/j.mpaic.2025.07.015","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 623-624"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050257","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}
{"title":"Pathophysiology and treatment of COVID and its perioperative management","authors":"Denis Chung Man Kwong, David Wai Tsan Ng","doi":"10.1016/j.mpaic.2025.07.003","DOIUrl":"10.1016/j.mpaic.2025.07.003","url":null,"abstract":"<div><div>The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed significant global challenges since 2019. Despite the subsequent emergence of the milder Omicron variant in November 2021, COVID-19 continues to cause significant morbidities and mortality, especially among the elderly and those with medical comorbidities. Its global impact necessitates a comprehensive understanding of its pathophysiology and management, particularly in perioperative settings. This review provides a comprehensive analysis of the pathophysiology and clinical features of acute COVID-19 and long COVID, current evidence-based treatment strategies and perioperative consideration. This review, tailored for anaesthetists and intensivists, emphasizes individualized care and multidisciplinary collaboration to improve outcomes of COVID-19 patients undergoing surgery.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 548-558"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050350","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}