{"title":"Pre-optimization of the anaemic patient","authors":"Sarah-Lindsay Holmes, Harriet Lucero","doi":"10.1016/j.mpaic.2024.09.012","DOIUrl":"10.1016/j.mpaic.2024.09.012","url":null,"abstract":"<div><div>Anaemia affects a significant number of preoperative patients and has independently been associated with increased morbidity and mortality. Identification, assessment, and treatment of preoperative anaemia is now widely accepted as a new standard of care for patients. There remains a lack of conclusive evidence that optimizing the haemoglobin (Hb) preoperatively impacts on the increased risks, but there is increasing evidence normalizing iron stores has a positive impact.</div><div>The commonest cause of anaemia in this setting is iron deficiency. It is important to consider and exclude other causes, there are established recommendations for screening investigations. Early identification allows time for Hb optimization. Oral iron replacement is advised first line, however there are often time constraints and tolerability concerns. In some circumstances surgical delay is appropriate. It is important patients understand the rationale behind management and are involved in the decision-making process. Where possible, red cell transfusions are avoided preoperatively given associations with worse surgical outcomes, there may be circumstances however where both transfusions and erythropoiesis stimulating agents are considered.</div><div>As evidence and research in this field grows hospitals should develop preoperative anaemia care pathways to ensure appropriate screening investigations are performed and management delivered.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 1-5"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143143469","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":"Iron metabolism","authors":"Emma MacGregor, Deirdre Conway, Mark A Henderson","doi":"10.1016/j.mpaic.2024.11.001","DOIUrl":"10.1016/j.mpaic.2024.11.001","url":null,"abstract":"<div><div>Iron – like most micronutrients – is not synthesized by the human body and is acquired from dietary sources. Total body iron (approximately 3000–5000 mg) is chiefly regulated by varying the rate of absorption, balancing daily loss. Iron undergoes a continual cycle of conservation and re-utilization, with precise physiological controls to avoid systemic toxicity from free iron. Iron exerts pivotal roles in oxygen transport by haemoglobin, adenosine triphosphate generation, and enzymatic function. Iron deficiency anaemia is often identified in the preoperative period. Furthermore, syndromes of iron overload and subsequent toxicity may arise from aberrant pathways of iron metabolism.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 53-56"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144013","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":"Clinical aspects of coagulation and haemorrhage","authors":"Muhammad Naim Che Rahimi, Nicola Curry","doi":"10.1016/j.mpaic.2024.09.011","DOIUrl":"10.1016/j.mpaic.2024.09.011","url":null,"abstract":"<div><div>Haemorrhage affects all patient groups. Coagulopathy (an abnormality of the clotting system) is closely interlinked with haemorrhage and can either place patients at risk of future bleeding or can exacerbate active ongoing bleeding. There are many causes of coagulopathy – both inherited and acquired. During major haemorrhage, the presence of an acquired coagulopathy increases the likelihood of a poor clinical outcome, and a patient is more likely to require large transfusion volumes, critical care admission and is three to four times more likely to die. Other forms of coagulopathy, such as drug-induced coagulopathy (anticoagulant/anti-platelet use), liver disease or inherited bleeding disorders, both increase the severity of any active bleeding and place patients at higher risk for future bleeding when exposed to a haemostatic challenge, such as surgery. This risk must be recognized and mitigated. This review focuses on the clinical aspects of coagulation and haemorrhage in all these patient groups.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 20-26"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144001","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":"Capillary dynamics, interstitial fluid and the lymphatic system","authors":"Andrew Haggerty, Mahesh Nirmalan","doi":"10.1016/j.mpaic.2024.10.004","DOIUrl":"10.1016/j.mpaic.2024.10.004","url":null,"abstract":"<div><div>The regulation of small blood vessels (arterioles, venules and capillaries) and the formation of interstitial fluid at the capillary beds is an important process in the understanding of the healthy circulation. Traditionally, Starling's forces have been at the very heart of our understanding of this system. However, more recent work shows that the transvascular fluid flux is significantly lower than what one would expect on the basis of Starling’s forces alone, and hence alternative explanations have been sought to understand the process of tissue fluid formation. In this context the role of the endothelial glycocalyx layer (or EGL) has drawn substantial interest. The EGL is a dynamic, active interface between the blood and the endothelial cells. It is formed by membrane-bound glycoproteins, proteoglycans and polysaccharides, producing a hydrated gel-like layer on the luminal surface of the vascular endothelium of approximately 500–2000 nm thickness. In this paper we review some of these emerging concepts and propose alternative ideas to understand some frequent clinical conditions and their treatment.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 61-68"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144010","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":"Ethics of pregnancy testing in patients undergoing anaesthesia and surgery","authors":"Rachel Fairlie, Paul McConnell","doi":"10.1016/j.mpaic.2024.10.002","DOIUrl":"10.1016/j.mpaic.2024.10.002","url":null,"abstract":"<div><div>A patient's pregnancy status should be determined prior to undergoing any procedure which has the potential to cause harm to a pregnant mother or fetus. Anaesthesia and surgery, alongside the associated physiological stress and radiation exposure, pose some increased risks to the pregnancy and developing fetus. The fetus is most vulnerable in the first trimester, when the mother is more likely to be unaware of the pregnancy. National guidance suggests all women of child-bearing potential should be offered a pregnancy test prior to surgery if pregnancy status is uncertain. The results of this test can be used to inform decision-making regarding anaesthetic and surgical techniques, and in relation to timing of surgery. Whilst the testing is done in part to protect the unborn child, the fetus in of itself has no legal personality or rights until birth, and ultimately the decision to consent to surgery is that of the patient. Elective procedures can be postponed to minimize the risk to the pregnancy of miscarriage or teratogenicity. Most patients will be able to consent to pregnancy testing and the procedure. Potential ethical issues arise if the patient lacks capacity or is under the age of 16.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 27-30"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144011","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 patients with sickle cell disease and other haemoglobinopathies","authors":"Kailash Bhatia, Nandini Sadasivam","doi":"10.1016/j.mpaic.2024.09.017","DOIUrl":"10.1016/j.mpaic.2024.09.017","url":null,"abstract":"<div><div>Sickle cell disease is an autosomal recessive multi-systemic blood condition, caused because of a mutation in chromosome 11 resulting in production of abnormal β globin of haemoglobin or HbS. The abnormality under specific conditions results in polymerization of the globin chain resulting in deformed sickle-shaped red cells. These haemolyse under adverse conditions resulting in occlusion within the circulatory system resulting in cardio-respiratory, neurological, renal, musculoskeletal and bone marrow dysfunction, along with increased susceptibility to infections leading to significant morbidity and mortality. The perioperative period provides the perfect milieu for exacerbations. Careful planning and preparation with haematology input, good oxygenation, multi-modal analgesia, hydration, antibiotic prophylaxis, and maintenance of normothermia are the key preventative strategies utilized in this setting. Hydroxyurea, voxelotor, blood transfusion and haematopoietic bone marrow transplant are the available options for treatment. L-glutamine is not currently used in clinical practice in UK.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 13-19"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143143999","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}
Olivia Coombs, Craig Carroll, Adam Swift, Harriet Lucero, Christopher Hamilton
{"title":"Strategies to avoid intra-operative blood transfusion","authors":"Olivia Coombs, Craig Carroll, Adam Swift, Harriet Lucero, Christopher Hamilton","doi":"10.1016/j.mpaic.2024.09.014","DOIUrl":"10.1016/j.mpaic.2024.09.014","url":null,"abstract":"<div><div>Transfusion of donor blood is sometimes unavoidable during the surgical episode. However, it is associated with increased morbidity and mortality, whilst interventions that reduce the need for donor transfusions have a positive impact on outcome. The principles underpinning reducing the need for transfusion are collectively known as ‘patient blood management’ which incorporates three pillars: anaemia management, limitation of blood loss and restrictive transfusion triggers. When used in combination, these principles appear the most effective way to limit the impact of surgical blood loss and reduce allogenic blood transfusions.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 6-12"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144000","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":"Physiology of red and white blood cells","authors":"Catherine E Armstrong, Luke Mason","doi":"10.1016/j.mpaic.2024.10.005","DOIUrl":"10.1016/j.mpaic.2024.10.005","url":null,"abstract":"<div><div>Blood is made up of plasma and formed elements, which are red blood cells, white blood cells and platelets. The red blood cells (erythrocytes) make up the vast majority of the cells present in the blood. Their principal function is the transport of oxygen from the lungs to the tissues and the transport of carbon dioxide from those tissues back to the lungs. This is due to the presence of haemoglobin, a protein that binds easily and reversibly with oxygen. The affinity of haemoglobin for oxygen changes under certain conditions allowing increased off-loading of oxygen at the respiring tissues as required. White blood cells (leucocytes) form the body's defence against invading pathogens. They can be subdivided into granulocytes and agranulocytes, which have different mechanisms of attack against those pathogens.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 48-52"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144012","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":"Characteristics of special circulations","authors":"Marina Sawdon","doi":"10.1016/j.mpaic.2024.09.016","DOIUrl":"10.1016/j.mpaic.2024.09.016","url":null,"abstract":"<div><div>Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by both extrinsic and intrinsic mechanisms; sympathetic vasoconstriction of the afferent arterioles reduces renal blood flow in response to a decrease in effective circulating volume, myogenic mechanisms and tubuloglomerular feedback, as well as the release of vasoactive metabolites from the vascular endothelium regulate renal blood flow intrinsically. Hepatic blood flow is delivered via the portal vein and hepatic artery, and the amount of flow varies in these vessels reciprocally to maintain constant total blood flow. The pulmonary circulation receives the entire cardiac output, and blood flow is regulated both passively and actively. Pulmonary vessels are highly distensible and can accommodate increases in blood flow without significant increases in pressure.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 57-60"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143143998","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.2024.11.012","DOIUrl":"10.1016/j.mpaic.2024.11.012","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 1","pages":"Pages 69-70"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144089","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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