Traumatic brain injury is a leading cause of mortality and long-term disability worldwide. It encompasses a broad spectrum of conditions with pathophysiological heterogeneity. Clinical treatment practices are also heterogenous due to disparities in care between, and within, low- and high-income care settings. Extra-cranial injury, present in half of all patients with severe traumatic brain injury, often associated with high-energy trauma, can cause systemic organ dysfunction and exacerbate secondary brain injury. Preventing this through protocolized assessment and prompt resuscitation remain the focus of the initial phase of care. Neurocritical care management of traumatic brain injury is a complex and multifaceted process that requires continuous integration of intracranial and systemic physiological monitoring. Advances in multidimensional frameworks for the characterization of traumatic brain injury, including biomarkers and advanced neuroimaging, may help to individualize therapies. Challenges remain, healthcare inequalities in high-income countries are exacerbated by inadequate focus on low-energy falls in older patients and follow-up in mild traumatic brain injury. In this review, we summarize current approaches to the care of patients with moderate-to-severe injury, with particular emphasis on specialized neurocritical care, and discuss key areas of uncertainty and evolving practice.
A detailed understanding of the anaesthetic management of the patient undergoing transsphenoidal pituitary surgery is essential for the neuroanaesthetist. These are common tumours in clinical practice and anaesthesia for this patient population can prove challenging. This is particularly in relation to hormone hypersecretion syndromes and disordered pituitary function as well as consequences from tumour mass effect. Hormone hypersecretion syndromes can lead to a potentially difficult airway, a history of central and obstructive sleep apnoea, cardiovascular instability and electrolyte imbalance with attention to perioperative steroid replacement of the utmost importance. In this article we explore the anatomy and physiology of the pituitary gland, the common clinical presentations of pituitary tumours, hormone hypersecretion syndromes, transsphenoidal pituitary surgery itself and the anaesthetic preoperative, intraoperative and postoperative management of these patients. Possible postoperative complications will also be discussed.
As the role of artificial intelligence (AI) is becoming increasingly present in our everyday lives, it is similarly growing rapidly in the field of anaesthesia and intensive care medicine. From administrative tools such as building rotas to research into robotic AI-assisted intubation. This article reviews current and emerging application of AI across operational support, risk assessment, closed loop monitoring and mechanical tasks such as airway management and peripheral nerve blockade.The development of advanced neural networks has opened the doors for machine learning models (ML) to process and interpret complex patient data to prognosticate preoperative risk and predict difficult airways with accuracy. Intraoperatively, automated systems using real-time physiological feedback can continuously adjust drug infusions with the goal of staying within the patient's specific optimal dosage window. As a result, reducing oversedation and enhancing recovery time.One step further in recent research has been the proposal of early robotic devices for tracheal intubation and image reconstruction tools for ultrasound-guided nerve blocks. Despite being in early stages and with numerous limitations about measurement of performance and validation against humans, there is promising evidence that there is potential for development.
Climate change is widely recognized as one of the greatest threats to human health. Anaesthesia and intensive care contribute significantly to the environmental burden of the healthcare sector, through energy-intensive equipment, high volumes of single-use consumables, and the use of potent anaesthetic gases. This article explores areas for improvement in sustainability as outlined by the Glasgow Declaration by the European Society of Anaesthesiology and Intensive Care. Sustainable anaesthetic practice requires both system-level change and individual clinician engagement, with cumulative small interventions offering meaningful reductions in healthcare-related emissions.
The use of cardiac implantable electronic devices (CIEDs) is ever increasing in an ageing population, and an increasing number of patients with these devices are encountered by perioperative healthcare providers when they present for surgery. Electromagnetic interference remains one of the most important risks to the safe functioning of CIEDs.This article explores the strategies for managing various CIEDs including leadless devices in the perioperative setting, highlighting the importance of thorough preoperative evaluation, appropriate reprogramming of devices or magnet placements, continuous intraoperative monitoring, management of intraoperative complications and postoperative assessment. Close multidisciplinary collaboration between anaesthesiologists and cardiologists that form the CIED team remain essential in ensuring patient safety and preventing adverse outcomes.
Computed tomography (CT) has become the gold standard imaging modality in adults for assessing cervical spine trauma, superseding plain radiography in most clinical scenarios, as it provides superior sensitivity and enables accurate classification. A systematic approach to CT cervical spine interpretation is essential for all clinicians involved in trauma care, particularly anaesthetists who must assess cervical spine stability prior to airway management. This article provides a structured review of CT cervical spine imaging in perioperative management.
Understanding the physiological effects of starvation is highly important in critical care and anaesthesia for two major reasons. First, it aids in the recognition and management of patients with significant malnutrition, including the identification and prevention of refeeding syndrome. Second, it helps clinicians balance the risks and benefits of preoperative fasting, particularly as modern enhanced perioperative care pathways increasingly advocate perioperative carbohydrate loading.Physiological changes occurring during the stress response have wide-ranging implications involving multiple organ systems. In response to stress, the hypothalamus initiates a cascade of neuroendocrine and metabolic changes that, although protective initially, can significantly disrupt normal physiological function. Therefore, strategies aimed at minimizing the stress response are crucial in the management of perioperative and critically ill patients, especially in conditions such as trauma, burns, and severe critical illness.Physiological adaptations occur during anticipation of exercise, throughout exercise itself, and during the recovery period. A patient's exercise tolerance is closely associated with improved postoperative outcomes, as it reflects their cardiopulmonary reserve. The level of physical training should therefore be considered during anaesthetic assessment and perioperative management, since trained athletes often demonstrate physiological characteristics that differ significantly from those of sedentary individuals.
Cervical spine disease is increasingly prevalent worldwide. Pathology encompasses degenerative, traumatic, neoplastic, inflammatory, and deformity-related conditions, many of which may necessitate surgical intervention. Anaesthetic management of patients undergoing cervical spine surgery presents unique challenges, particularly with respect to airway management, neurological protection, haemodynamic stability, and patient positioning. This review outlines common cervical spine pathologies, surgical approaches, and key perioperative anaesthetic considerations, including induction and maintenance strategies, intraoperative monitoring, airway management, multimodal analgesia, and postoperative care. Recent recommendations for airway and blood pressure management in patients with cervical spine injury are also discussed, alongside the role of enhanced recovery after surgery (ERAS) pathways. A structured, multidisciplinary approach is essential to optimize patient safety and overall outcomes.
The immediate postoperative period after neurosurgery is characterized by substantial physiological vulnerability and a risk of rapid neurological deterioration. Postoperative care must therefore combine prompt recognition of evolving intracranial complications with meticulous optimization of systemic factors that influence cerebral perfusion and oxygenation. This review outlines the general principles of postoperative care for neurosurgical patients, with an emphasis on practical bedside management in the recovery. Core priorities include appropriate postoperative destination, structured handover, airway and ventilatory management, pathology-specific haemodynamic control, and frequent, trend-based neurological assessment with predefined escalation thresholds. Supportive management of fluid balance, sodium and water disorders, glucose, temperature, infection risk, and device-related complications is also essential. Analgesia and antiemetic strategies must provide symptom control without obscuring neurological assessment. Enhanced recovery principles, thromboprophylaxis, rehabilitation planning, and safe discharge processes are crucial pillars of postoperative care. A structured multidisciplinary approach is fundamental to reducing preventable morbidity and supporting safe recovery after neurosurgery.
