Anaesthesia & intensive care medicine - Current Issue

Metabolism encompasses the totality of chemical reactions occurring within the body's cells, which are broadly classified into anabolic, catabolic, and amphibolic pathways. Intermediary metabolism refers to the interconnected network of these reactions, where nutrients are converted into energy and building blocks for biosynthesis. Anabolic pathways synthesize complex molecules from simpler precursers, e.g. glycogen synthesis from glucose. These pathways are divergent and require energy, which is derived from adenosine triphosphate (ATP) hydrolysis into adenosine diphosphate and inorganic phosphate.

Shock is a life-threatening clinical state in which cellular hypoxia develops due to an imbalance between oxygen supply and demand resulting in end organ dysfunction. It is the end result of a number of pathophysiological processes, and multiple processes may coexist. Shock may be reversible in early stages; however, if appropriate treatment is delayed the effects become irreversible, resulting in multiorgan failure and death. Given the morbidity and mortality associated with shock, its significance has been emphasized in medical education and public health campaigns globally in recent years.

Clinical coding is the process of converting health information, which may be a combination of free text language and a clinician’s interpretation of this, into a computer-readable formal language. Well-known examples of clinical coding systems include the International Classification of Diseases (ICD-10) and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT). These coding systems exist to avoid the complexities and ambiguity of human language and convey benefit to both individual clinicians and patients, but also by allowing for data analysis at the scale of entire populations.

Maintenance of anaesthesia

Understanding the role of macronutrients and micronutrients and how energy requirements vary during different phases of acute illness is necessary when caring for the critically ill. Macronutrients, which include proteins, carbohydrates and fats, supply energy and are the building blocks for the human body. Micronutrients include vitamins and trace minerals and are required in much smaller quantities than macronutrients, but play vital roles in maintaining optimum health. The delivery of medical nutrition therapy can be optimized either by estimating energy requirements using theoretical formulae, or by measuring a patient's energy expenditure using indirect calorimetry.

The human body has acquired mechanisms to support life against the continual onslaught of pathogenic, physical and chemical threats. The first defences are the physical barriers of the skin and mucosae, both of which have unique adaptations to protect these vulnerable ports of entry. Our second line of defence is held by the innate immune system, a network of antigen non-specific phagocytes, antimicrobial peptides, natural killer cells and inflammatory mediators. Finally, our third line of defence is formed by our adaptive acquired immunity which provides antigen-tailored responses and the formation of immunologic memory.

Pulmonary embolism (PE) is a significant cause of hospitalization, morbidity and mortality, frequently requiring critical care services. Critically ill patients are also at increased risk of developing venous thrombo-embolism (VTE) and acute PE. Critical care clinicians should therefore be confident in their approach to the patient with suspected and diagnosed PE. Furthermore, the co-morbid conditions in this patient group may present additional challenges both in diagnosis (e.g. safe access to radiology) and management (e.g.

Record-keeping during the perioperative period by anaesthetists is a fundamental part of modern anaesthetic practice. This article explores the numerous functions of the anaesthetic record, and highlights the practice guidelines governing their suggested content. The advantages and disadvantages of an electronic record-keeping system are also explored.

Key goals for the maintenance phase of general anaesthesia are the provision of surgical anaesthesia while maintaining physiological parameters at levels that preserve organ function and avoid injury. Maintenance can be achieved with either inhaled or intravenous anaesthetic agents. A good understanding of the physiochemical properties of these agents is necessary for effective manipulation of depth of anaesthesia at any stage. Drugs suitable for total intravenous anaesthesia are mainly those with short context-sensitive half-times, such as propofol, remifentanil, and dexmedetomidine.

A database is a structured collection of data. Databases allow clinical data to be stored in a reliable and accessible way for clinical care, research, and quality improvement. Understanding how such clinical data is stored, accessed, and analysed is no longer a niche skill but a core professional competency. This article builds on the foundational principles of relational databases and SQL to explore the expanding landscape of NoSQL databases which are increasingly used for analysing complex, unstructured data in areas like precision medicine and operational research, and situates this knowledge within the contemporary UK context, explaining the architecture and clinical implications of the NHS Federated Data Platform (FDP).