{"title":"Consent for anaesthesia: considerations in children and young people","authors":"Niall Tierney, Caoimhe Casby, Barry Lyons","doi":"10.1016/j.mpaic.2024.07.002","DOIUrl":"10.1016/j.mpaic.2024.07.002","url":null,"abstract":"<div><div>The law relating to consent for medical interventions in children is complex. Children, when they are old or mature enough can consent for themselves, but the legal rules around this vary by jurisdiction. When they are unable to consent, this must be sought from someone with parental responsibility. This article discusses consent, and its refusal, to medical interventions by children, adolescents and parents.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 703-707"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419791","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":"Histamine and antihistamines","authors":"Martin Ince, Peter Ruether","doi":"10.1016/j.mpaic.2024.06.007","DOIUrl":"10.1016/j.mpaic.2024.06.007","url":null,"abstract":"<div><div>Histamine is one of the most important and extensively studied biological molecules in the human body. It plays a constitutive role within almost every bodily system, but most notably within the stomach, where it regulates acid secretion, the central nervous system, where it acts as a neurotransmitter, the cardiovascular system, where it affects cardiac output and vascular permeability, and it has a well-established role in allergy and anaphylaxis. Histamine exerts its effects through four distinct receptor subtypes: H1, H2, H3 and H4. Predominantly, though not exclusively, these take the form of G-protein-coupled receptors. Clinically used antihistamines demonstrate inverse agonism to the histamine receptor and drugs are available with activity at H1, H2 and H3 receptors. H1 antihistamines are used in the treatment of allergy, and are classified as either first or second generation. First-generation antihistamines have significant sedative side effects. H2 antihistamines are predominantly used for the treatment of gastrooesophageal reflux and peptic ulcer disease; however, the most widely used of these, ranitidine, has been withdrawn from use due to (impurity related) safety concerns. H3 antihistamines have been explored for the treatment of neurological disease and to date the only licensed H3 antihistamine is used for the treatment of narcolepsy. Multiple uses have been suggested for H4 antihistamines, including immunomodulation, the treatment of asthma and even as an analgesic. However, no (commercially available) drug exists as of yet.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 734-740"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419794","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":"Recognition of the critically ill patient and escalation of therapy","authors":"Amy Brown, Apoorva Ballal, Mo Al-Haddad","doi":"10.1016/j.mpaic.2024.06.009","DOIUrl":"10.1016/j.mpaic.2024.06.009","url":null,"abstract":"<div><div>Critical illness often involves multiple organ failures and is associated with significant morbidity and mortality. In the vast majority of patients, there is a recognizable period of physiological deterioration which heralds the development of organ failure and critical illness. Despite efforts to improve the detection and management of critical illness, signs of deterioration are often missed and decisions to move patients to critical care units are delayed. Standardized approaches which implement an effective ‘chain of response’ are now utilized worldwide. They focus on attempting to reduce the incidence of serious adverse events (SAEs) such as in-hospital cardiac arrest and unplanned intensive care unit (ICU) admission using preventative measures. These systems should include: accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, rapid bedside patient assessment by trained teams and appropriate interventions. Early warning systems (EWS) are an important part of this and can help identify patients at risk of deterioration and SAEs. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized communication framework between professionals. Lastly, timely support and input from members of the critical care team are vital to ensure optimal outcomes for critically ill patients.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 637-641"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419701","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":"Pharmacological modulation of cardiac function and control of blood vessel calibre","authors":"John Nicholls, Elliott Bertram-Ralph","doi":"10.1016/j.mpaic.2024.08.002","DOIUrl":"10.1016/j.mpaic.2024.08.002","url":null,"abstract":"<div><div>The myocardium and vascular system are influenced by the neurological, paracrine and endocrine systems to control blood pressure in health. Blood pressure control is crucial to maintain adequate organ perfusion and function. In disease, the homeostatic mechanisms that control these systems are dysregulated, which can lead to organ failure. Therefore, understanding the means of manipulating these systems using anaesthesia is important. The central nervous system, cardiac muscle and vascular smooth muscle all have physiological processes which can be targeted to reduce the stress response associated with their derangement. This article reviews the different pharmacological means of altering cardiac function and blood vessel calibre to improve organ perfusion.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 723-733"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419793","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":"Update on ENT anaesthesia in children","authors":"Rory W Blackler, Zoë E Brown, Neil K Chadha","doi":"10.1016/j.mpaic.2024.06.011","DOIUrl":"10.1016/j.mpaic.2024.06.011","url":null,"abstract":"<div><div>This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing proportion are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea (OSA), so judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities, and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including recent advances in ENT surgery that have an impact on the anaesthetist.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 708-713"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419792","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":"Haematological problems in intensive care: recent advances and developments","authors":"Samantha Gaw, Christopher J Wright","doi":"10.1016/j.mpaic.2024.07.004","DOIUrl":"10.1016/j.mpaic.2024.07.004","url":null,"abstract":"<div><div>There have been significant changes in the management of several haematological conditions over the last decade. This article focuses on three key areas – chimeric antigen receptor (CAR) T-cell therapy, haemophagocytic lymphohistiocytosis (HLH) and thrombotic thrombocytopenic purpura (TTP) – and the implications these areas have for clinicians working in intensive care medicine. There is particular focus on CAR T-cell therapy given its novel nature and implications for both critical care practice and resource utilization.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 10","pages":"Pages 657-663"},"PeriodicalIF":0.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419797","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":"Bacterial infections of the respiratory tract and their pharmacological treatment","authors":"Abubaker Eltayeb, Susannah Leaver","doi":"10.1016/j.mpaic.2024.06.006","DOIUrl":"10.1016/j.mpaic.2024.06.006","url":null,"abstract":"<div><p>Bacterial infections of the respiratory tract contribute to significant morbidity and mortality worldwide. Early recognition of lower respiratory tract infections is fundamental for the management and prevention of complications such a sepsis. Common respiratory infections such as community-acquired, hospital-acquired pneumonia, atypical bacterial infection, and acute infective exacerbations of chronic disease such as chronic obstructive pulmonary disease and bronchiectasis are caused by a wide range of pathogens which can be treated in the community or in the hospital setting based on assessment of severity. Antibiotics are by far the most commonly used pharmacological intervention in the management of bacterial infections. Antibiotics have different and unique mechanisms of action against bacteria and several guidelines exist to direct treatment of chest infections. However, with inappropriate use of antibiotics, the resistance of bacteria to antimicrobials has seen significant growth globally, causing concern to the public health. Other pharmacological interventions for the management of infections and sepsis are in the development phase.</p></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 9","pages":"Pages 623-629"},"PeriodicalIF":0.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148235","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.2024.08.001","DOIUrl":"10.1016/j.mpaic.2024.08.001","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 9","pages":"Pages 635-636"},"PeriodicalIF":0.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148237","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":"Measurement of respiratory function: gas exchange and its clinical applications","authors":"Salahuddin M. Qureshi, Rehan Mustafa","doi":"10.1016/j.mpaic.2024.06.003","DOIUrl":"10.1016/j.mpaic.2024.06.003","url":null,"abstract":"<div><p>Gas exchange is the main function of the lungs. Lungs have a large reserve for gas exchange. Oxygen and carbon dioxide diffuse along their partial pressure gradient across the alveolar–capillary membrane. Alveolar ventilation and pulmonary circulation are closely matched to provide efficient gas exchange in the lungs. Hypoxaemia often results from mismatch in ventilation–perfusion. Gas exchange can be impaired in various disease states. Measurement of the diffusing capacity for carbon monoxide (DLCO) provides estimation of the gas exchange function. A low DLCO indicates an impairment of oxygen transfer across the alveolar–capillary membrane. Based on the lung function tests one can assess the risks of perioperative pulmonary complications. Anaesthesia and surgery adversely affect pulmonary function, many of which adverse effects can be prevented.</p></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 9","pages":"Pages 616-622"},"PeriodicalIF":0.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148234","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":"Statistics in clinical trials","authors":"Roddy McDermid","doi":"10.1016/j.mpaic.2024.06.005","DOIUrl":"10.1016/j.mpaic.2024.06.005","url":null,"abstract":"<div><p>This article describes the role of statistics in clinical trials, covering study design, directionality, variables, randomization and blinding, error reduction, probability and ethics as applied to trial design.</p></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"25 9","pages":"Pages 630-634"},"PeriodicalIF":0.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148236","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}