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The paper offers an overview of pain intervention procedures which are just one facet of a holistic approach to managing pain. They can have a therapeutic and/or diagnostic focus, at times being useful in terms of guiding the clinician to useful pointers to the source of pain, and at others allowing windows of opportunity of pain relief to allow the patient to engage with other modes of pain management such as physiotherapy or occupational therapy with a common goal of improving level of function.

Chronic pain is complex and difficult to assess and manage. The biopsychosocial model and a multidisciplinary approach provide a framework for assessing and managing chronic pain. Clinical psychologists work as part of the multidisciplinary pain team to assess, formulate and provide interventions for individuals with chronic pain. One approach psychologists use is Acceptance and Commitment Therapy (ACT), which is a mindfulness-based therapy that focuses on psychological flexibility and valued engagement in life.

Stillbirth is a devastating pregnancy outcome for families. Antenatal and intrapartum surveillance has evolved to ensure accurate and regular risk assessments are conducted to allow earlier detection of adverse outcomes without introducing unnecessary interventions. In this article, we outline the latest national guidelines regarding antenatal and intrapartum surveillance in the UK and their implementation into clinical practice. Through discussing latest developments in evidence-based interventions, we explore how clinicians are striving to continue to optimize maternal care practices and work towards the continued reduction in stillbirth rates.

Jehovah’s Witnesses are a Christian denomination with around 8 million members worldwide. They belief the teachings of the Bible prohibit the transfusion of blood and blood components. Some blood products may be deemed acceptable as part of their beliefs and they may be accepting of intraoperative techniques such as cell salvage. Jehovah’s Witnesses have the right to accept or refuse treatment without providing a reason for doing therefore medical practitioners must respect this even if it would pose threat to the patient’s life.

Which of the following are true regarding the properties and medical uses of an oxygen concentrator?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms of such damage.” Analgesics can be broadly classified according to their role primarily on nociception as well as pain perception, both of which are intimately integrated to the pain experience. An understanding of the pain pathway is inherent to a good understanding of how therapeutic targets can act as analgesics.

Difficult intubation in obstetric anaesthesia remains an important cause of maternal morbidity and mortality. Recent quoted estimates for difficult intubation vary between 1:19 and 1:49 whilst for failed intubation they vary between 1:180 and 1:808. Physiological changes during pregnancy, low general anaesthesia (GA) rates in obstetrics contributing to limited training opportunities, increased obstetric activity performed out-of-hours, a time-pressure environment, isolated location, and obstetric emergencies for which a GA is often utilized are cited contributing to difficult and failed intubation in obstetrics.

Caesarean birth remains the most performed obstetric surgical procedure globally. In the UK, though most caesarean births are performed under neuraxial anaesthesia, general anaesthesia (GA) remains the quickest option for emergency caesarean birth, and may be more appropriate for complex cases, such as those involving placenta accreta spectrum disorder. Propofol and rocuronium use for GA for caesarean birth in the UK is increasing. Whilst the evidence for routine use of videolaryngoscopy in the obstetric population is currently lacking, there is a growing interest in this, as well as the use of apnoeic oxygenation, total intravenous anaesthesia and processed electroencephalography for obstetric GA.

Anxiolytics, sedatives, and hypnotics play a pivotal role in modern clinical practice, facilitating procedures, managing anxiety, and ensuring adequate sedation in various healthcare settings. This article provides a comprehensive overview of their mechanisms of action, highlighting how these agents modulate central nervous system activity to achieve therapeutic effects. Benzodiazepines and α-2 adrenergic agonists are discussed as cornerstone agents, detailing their pharmacodynamic and pharmacokinetic profiles.

The range of infectious diseases encountered whilst working in resource-limited settings varies enormously depending on where in the world one is working, although the majority of low- and middle-income countries lie within the tropics. Human immunodeficiency virus (HIV), tuberculosis (TB) and malaria are commonly encountered when working in tropical countries and may have implications upon the conduct of anaesthesia, either as a direct result of the condition, or due to interaction with the drugs used in its management.

How we measure pain and patients’ responses to pain is key in developing both our understanding and treatment of it. This article outlines the application of tools for the measurement of clinical outcomes used in acute and chronic pain medicine; what makes a good outcome measurement and how this can be utilized in clinical and research practice is discussed. Various tools for outcome measurement are described including those which may be utilized in various patient groups.

This article considers why enhanced communication techniques are particularly important in pain management consultations. Background is provided from evidence in both primary and palliative care research. The techniques are introduced and explained and include generic communication skills appropriate for all consultations and more advanced techniques. The generic skills described are empathy, allaying anxiety, breaking bad news and shared decision-making. Advanced techniques are aimed at facilitating changes in behaviour and include coaching, mentoring and motivational interviewing.

Regional anaesthetic techniques are the commonest type of anaesthetic for caesarean birth primarily due to their safety profile compared to general anaesthesia in pregnant women. The selection of a regional technique is influenced by both patient and surgical factors. Caution is essential regarding the timing of regional anaesthesia in patients who are receiving anticoagulation or have clotting abnormalities. Information on the risks and benefits of regional anaesthesia should be provided to facilitate informed decision-making.

Central neuraxial blocks represent the most executed procedures in the field of obstetric anaesthesia. Most neurological complications observed in the post-partum period arise from obstetric palsies associated with the natural process of labour. It is crucial for anaesthetists to adopt a systematic methodology when evaluating neurological injuries to differentiate between causes related to anaesthesia and those that are not. Additionally, it is vital to promptly recognize circumstances that necessitate urgent investigation and intervention to avert lasting damage.

Postdural puncture headache (PDPH) is a complication of dural puncture resulting from cerebrospinal fluid leak associated with performance of neuraxial analgesia, neuraxial anaesthesia or a lumbar puncture. Given that neuraxial techniques are frequently employed during childbirth, PDPH is more particularly prevalent among women in the postpartum period. PDPH typically presents within 5 days post-procedure with a fronto-occipital headache, often postural in nature, accompanied by symptoms such as neck stiffness, visual and/or auditory disturbances.

Human factors and ergonomics play a crucial role in improving patient safety, team performance and clinical outcomes. The dynamic, high-risk situations encountered in obstetrics require a rapid, well-coordinated response from a highly functioning team. An understanding of the interaction of healthcare professionals with members of their team and their environment is essential. Lack of situational awareness, poor communication and inadequate leadership compounded by unfamiliar teams in a rapidly deteriorating clinical situation put obstetric patients at particular risk.

Medical consent, the process of agreeing the benefits and risks of a treatment or procedure, has specific challenges in pregnancy and labour. Consent should take the form of a discussion about risk and include the alternatives. It should be an ongoing process with the right to withdraw consent or seek further information if the person chooses. Ideally all risks to which the patient might attach significance should be discussed. To consent, a person must have capacity. It is accepted that while labour can involve stress, pain, and fatigue, and will not infrequently be in a time-critical situation, women will normally retain the capacity to consent.

Cardiovascular disease remains one of the leading causes of pregnancy-related mortality in the developed world. Preconception counselling is essential to highlight individualized maternal, fetal, and cardiac risks. Pregnant individuals with a high-risk cardiac condition should be managed by a multidisciplinary cardio-obstetrics team comprising a high-risk obstetrician, cardiologist, neonatologist, and an anaesthetist in a tertiary centre. Anaesthetists as peripartum physicians need to comprehend the haemodynamic changes occurring during pregnancy, labour and postpartum period which can exacerbate pre-existing cardiac conditions resulting in haemodynamic compromise.