{"title":"Functions of the placenta","authors":"W Ross Macnab","doi":"10.1016/j.mpaic.2025.01.017","DOIUrl":"10.1016/j.mpaic.2025.01.017","url":null,"abstract":"<div><div>The placenta is an organ that connects a developing fetus to the uterine wall for the exchange of nutrients, antibodies and hormones between mother and fetus. The development of the placenta is essential for the removal of waste products, for fetal growth, development and the maintenance of a healthy pregnancy and it is an important endocrine organ.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 216-219"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800242","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":"Uterine physiology","authors":"W Ross Macnab","doi":"10.1016/j.mpaic.2025.01.016","DOIUrl":"10.1016/j.mpaic.2025.01.016","url":null,"abstract":"<div><div>The uterus serves the essential function of supporting the fetus throughout the duration of pregnancy until childbirth. It is anatomically divided into three main sections: the fundus, the body, and the cervix. The functioning of the uterus is primarily regulated by hormones, which induce considerable transformations during pregnancy. At the time of delivery, alterations in hormonal levels trigger cervical remodelling and uterine contractions, resulting in the expulsion of the fetus. Various medications can influence uterine activity and may be utilized to either initiate or inhibit labour.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 213-215"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800241","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.2025.01.002","DOIUrl":"10.1016/j.mpaic.2025.01.002","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 181-182"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629547","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":"Total intravenous anaesthesia in children: a practical guide","authors":"Sarah Greenaway, Hannah Lewis","doi":"10.1016/j.mpaic.2024.12.003","DOIUrl":"10.1016/j.mpaic.2024.12.003","url":null,"abstract":"<div><div>Total intravenous anaesthesia (TIVA) is the delivery of general anaesthesia entirely via the intravenous route. This can be achieved through a variety of drugs. The most common combination used is propofol and a short-acting opiate, such as remifentanil. Different target- controlled infusion (TCI) models are used, depending on the age of the child.</div><div>TIVA use in paediatric anaesthesia offers certain benefits over volatile anaesthesia. Advantages for the patient include reduced postoperative nausea and vomiting (PONV), delirium, time in recovery and less airway reactivity. It provides a safe method of anaesthesia for children with certain conditions who cannot have volatile anaesthesia. There are also environmental benefits to using TIVA instead of volatile anaesthesia and surgical benefits, for example in cases requiring somatosensory monitoring.</div><div>TIVA use in paediatrics is increasing and this article will provide an overview of use in the paediatric population as well as some of the barriers and disadvantages.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 168-174"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629555","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 anaesthetic techniques for paediatric surgery","authors":"Babette Clinck, Katie Misselbrook, Andrew Dooley","doi":"10.1016/j.mpaic.2024.12.004","DOIUrl":"10.1016/j.mpaic.2024.12.004","url":null,"abstract":"<div><div>Peripheral nerves blocks provide intra- and postoperative analgesia and are an important element of the multimodal approach to perioperative pain. This is particularly important in the paediatric population, where the side effects of opioids, such as respiratory depression, postoperative nausea and vomiting (PONV), and gastrointestinal motility issues, can be especially challenging. The addition of a block to the multimodal strategy allows in most situations for a significant dose reduction in opioid requirements and in some cases to a complete avoidance of opioids. In addition to this, the faster recovery times, the early discharge, and the shift to performing more procedures in day case have led to an increased popularity of using regional blocks in children. This article aims to discuss current practices, benefits and challenges associated with nerve blocks in children and offers a general approach to performing common ultrasound-guided regional techniques in the paediatric population.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 155-161"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629546","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":"Paediatric day case surgery","authors":"Charlotte Berwick, Steve Roberts","doi":"10.1016/j.mpaic.2024.12.001","DOIUrl":"10.1016/j.mpaic.2024.12.001","url":null,"abstract":"<div><div>Paediatric day case surgery is suitable for many children and procedures, offering benefits to patients, families and organizations. For day surgery units to be successful, thorough processes must be followed to ensure that patients are correctly selected and prepared, lists are organized appropriately, and resources are in place to manage day case smoothly. Techniques for anaesthesia and analgesia should be tailored to facilitate day case discharge with clear information provided to patients and families.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 143-147"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629552","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}
Gagandeep S Panesar, Naveen C Murali, Nicholas Tabiner
{"title":"General principles of paediatric anaesthesia","authors":"Gagandeep S Panesar, Naveen C Murali, Nicholas Tabiner","doi":"10.1016/j.mpaic.2025.01.001","DOIUrl":"10.1016/j.mpaic.2025.01.001","url":null,"abstract":"<div><div>Annually in the UK, around half a million children and infants undergo general anaesthesia. The provision of anaesthesia for this patient group can be a daunting task; the size of the patient is very variable, disease states and pathology are present that are not seen in other areas of practice, and there are substantial challenges of communicating and allaying anxiety. Additionally, unique medicolegal concepts exist. As those charged with the patients care during unique situations, it is important for anaesthetists to have a holistic understanding of the treatment they will be providing.</div><div>We have sought to consolidate the key areas of practice into core principles that can be applied to neonates, infants and children, to allow the reader insight into the foundations of safe paediatric anaesthetic conduct. Key important differences in these patient groups are outlined, including anatomy, drug handling and fluid requirements. Essential concepts of preoperative assessment and management of the anxious child are included, to provide colleagues with the tools for identification and management of challenging scenarios.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 129-138"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629550","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":"Pain assessment in children","authors":"Davina Wong","doi":"10.1016/j.mpaic.2024.12.008","DOIUrl":"10.1016/j.mpaic.2024.12.008","url":null,"abstract":"<div><div>Causes of childhood pain include peri-procedural, injury and disease. Systematic reviews have shown that pain can lead to anxiety, sleep disturbance, and have deleterious effects on daily life.</div><div>Experienced pain is influenced by biological, psychological and social factors. Pain assessment in children is particularly challenging due to the wide variation in physiological responses, communication abilities and developmental stages of this group of patients. For example, their limited verbal repertoire can lead to an under-recognition of pain as compared to adults who may be better able to articulate their pain.</div><div>Childhood pain has an effect in the short-term not only on the child but their carers. Long-term effects of unrecognized, undertreated or poorly managed pain can lead to important cognitive and behavioural consequences. This can lead to anticipatory anxiety and can lead to more difficulty in management of pain during future episodes of illness or future treatments.</div><div>Well-managed pain is associated with faster recovery, fewer complications and decreased health care resources. Regular assessment and documentation of pain, using appropriate tools for development age and ability, is essential in order to assess efficacy of pain treatments.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 139-142"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629551","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":"Procedural sedation for children: principles and practice","authors":"Mark Dunham","doi":"10.1016/j.mpaic.2024.12.002","DOIUrl":"10.1016/j.mpaic.2024.12.002","url":null,"abstract":"<div><div>Sedation of children is often an unavoidable component of many diagnostic and therapeutic healthcare interventions in children. Traditional agents such as chloral hydrate and midazolam continue to be widely used in a safe and effective manner. However, experience with other agents has grown in recent years. This produced more options and shifted attitudes on how sedation may be defined, conceptualized and delivered. This article discusses these changes, as well as covering some of the non-pharmacological factors and issues involved.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 162-167"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629554","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":"Crystalloids, colloids, blood and blood products and substitutes","authors":"Patrick J Neligan","doi":"10.1016/j.mpaic.2024.12.005","DOIUrl":"10.1016/j.mpaic.2024.12.005","url":null,"abstract":"<div><div>Intravenous fluids are a core therapy in critical care and perioperative practice. Although most fluids that we use today are very similar to those of the mid 20<sup>th</sup> Century, our understanding of the physiology of the cardiovascular system, the microcirculation and the extravascular space has evolved considerably. In modern practice, thought should be given to the distribution of stressed and unstressed blood volume, the glycocalyx and the gelatinous interstitial matrix. All of these components change dynamically in volume depleted states.</div><div>In the dehydrated patient, if given slowly, most intravenous fluid remains in the circulation. However, if delivered rapidly, much of the it extravasates into the interstitium causing hydraulic damage and oedema.</div><div>In general, isotonic balanced crystalloid solutions should be used in preference to 0.9% saline for resuscitation, and hypotonic crystalloid solutions, containing generous quantities of potassium, should be used for maintenance. There is minimal indication for colloidal products in modern medicine, with the exception of human albumin solution in liver disease. Blood products are indicated as the primary resuscitation tool in haemorrhagic shock.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 175-180"},"PeriodicalIF":0.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629505","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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