British journal of anaesthesia
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Anaesthesiologists overwhelmingly favour pulse wave analysis techniques as their primary method to monitor cardiac output during high-risk noncardiac surgery. In patients with a radial arterial catheter in place, pulse wave analysis techniques have the advantage of instantly providing non-operator-dependent and continuous haemodynamic monitoring information. ⋯ They have the advantage of minimising plastic waste and related carbon dioxide emissions, and also significantly reducing hospital costs. The future integration of pulse wave analysis algorithms into multivariable bedside monitors, obviating the need for standalone haemodynamic monitors, could lead to wider use of haemodynamic monitoring solutions by further reducing their cost and carbon footprint.
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William Harvey discovered that the cardiovascular system is a closed hydraulic circle. Since that discovery, many haemodynamic models have strayed by dividing the circulation into segments, which can be misleading. An alternative model is presented that both preserves circular hydraulics and provides a comprehensive picture of overall cardiovascular function using a novel cardiovascular vector graphic. The practical value of this approach resides in its ease of visualising critical physiological variables and ease of predicting and communicating how changes in those variables affect function.
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Prescriptions and use of glucagon-like peptide-1 (GLP-1) receptor agonists are increasing dramatically, as indications are expanding from the treatment of diabetes mellitus to weight loss for people with obesity. As GLP-1 receptor agonists delay gastric emptying, perioperative healthcare practitioners could be concerned about an increased risk for pulmonary aspiration during general anaesthesia. We summarise relevant medical literature and provide evidence-based recommendations for perioperative care for people taking GLP-1 receptor agonists. ⋯ The risk of aspiration during general anaesthesia is unknown. However, we advise caution in patients who recently commenced on GLP-1 receptor agonists. After over 12 weeks of treatment, standard fasting times likely suffice to manage the risk of pulmonary aspiration for most otherwise low-risk patients.
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Practitioners can face significant challenges when managing the airways of infants and neonates because of their unique anatomical and physiological features. The requirement for emergency airway management in this age group is rare. Details of emergency airway techniques in paediatric practice guidelines are missing or lack consensus, and it is known that outcomes for affected children can be poor. ⋯ So, what happens when such a practitioner encounters this life-or-death scenario and feels ill-equipped to act? The ethical and legal issues surrounding the management of this emergency are clearly defined, but they can be unknown or misunderstood by doctors. Compounding the extreme stress of the scenario is the moral and ethical dilemma of whether to act or not. The following discussion explores these issues and examines the philosophical and psychological perspectives.
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Editorial
Rethinking ketamine as a panacea: adverse effects on oxygenation and postoperative outcomes.
Ketamine is receiving renewed interest in perioperative medicine as an anaesthetic adjunct and a treatment for chronic conditions, including depression. Ketamine's complex pharmacologic profile results not only in several desirable effects, such as anaesthesia and analgesia, but also multiple adverse effects affecting the central nervous, cardiovascular, and respiratory systems. In addition to defining patient-centred outcomes in future clinical studies on the perioperative uses of ketamine, careful monitoring for its numerous adverse effects will be paramount.