Eye signs in anaesthesia and intensive care

Ophthalmology can be unfamiliar territory for the anaesthetist and intensivist. This article describes the signs associated with iatrogenic injury to the eye in the operating theatre and the intensive care unit. Patients are at risk of corneal abrasions, exposure keratopathy and chemosis. The prone patient encounters an additional risk of ischaemic optic neuropathy and acute glaucoma. In the intensive care setting, the intensivist should be alert to signs of ocular infection, for example, conjunctivitis, microbial keratitis and endophthalmitis. In the trauma patient, careful evaluation of the eye is required to rule out sight-threatening conditions such as retrobulbar haemorrhage, globe rupture, orbital fractures and retinal detachment.     

Care of the eye during anaesthesia and intensive care

This article describes care of the eye through a period of potential vulnerability, during patient management under general anaesthesia and in the intensive care unit. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries are covered, as well as good practice points and preventative measures pertinent to all anaesthetists and intensive care staff.     

Care of the eye during anaesthesia and intensive care

This article describes care of the eye during a period of vulnerability in anaesthesia and intensive care. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries will be covered as well as good practice points and preventative measures pertinent to all anaesthetists and critical care practitioners.     

Eye signs in anaesthesia and intensive care medicine

Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner’s syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting.     

Eye signs in anaesthesia and intensive care medicine

Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner's syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting.     

Eye signs in anaesthesia and intensive care medicine

Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner's syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting.     

Eye signs in anaesthesia and intensive care medicine

Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner’s syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting.     

Mitochondria in anaesthesia and intensive care

Objective

Mitochondria play a key role in energy metabolism within the cell through the oxidative phosphorylation. They are also involved in many cellular processes like apoptosis, calcium signaling or reactive oxygen species production. The objectives of this review are to understand the interactions between mitochondrial metabolism and anaesthetics or different stress situations observed in ICU and to know the clinical implications.

Data sources

References were obtained from PubMed data bank (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the following keywords: mitochondria, anaesthesia, anaesthetics, sepsis, preconditioning, ischaemia, hypoxia.

Data synthesis

Mitochondria act as a pharmacological target for the anaesthetic agents. The effects can be toxic like in the case of the local anaesthetics-induced myotoxicity. On the other hand, beneficial effects are observed in the anaesthetic-induced myocardial preconditioning. Mitochondrial metabolism could be disturbed in many critical situations (sepsis, chronic hypoxia, ischaemia-reperfusion injury). The study of the underlying mechanisms should allow to propose in the future new specific therapeutics.     

Epilepsy in anaesthesia and intensive care

Epilepsy is defined as recurrent (two or more) epileptic seizuresunprovoked by any immediately identifiable cause. A seizurecan be defined as the clinical manifestation of an abnormaland excessive discharge of neurones, which is seen as alterationof consciousness, motor, sensory or autonomic events. Epilepsyis relevant to the anaesthetist for several reasons, for examplemedication and drug interactions, postoperative seizures, andintensive care management of status epilepticus.     

Filters in anaesthesia and intensive care

The use of various types of filters in anaesthesia and intensive care seems ubiquitous, yet authentication of the practice is scarce and controversies abound. This review examines evidence for the practice of using filters with blood and blood product transfusion (standard blood filter, microfilter, leucocyte depletion filter), infusion of fluids, breathing systems, epidural catheters, and at less common sites such as with Entonox inhalation in non-intubated patients, forced air convection warmers, and air-conditioning systems. For most filters, the literature failed to support routine usage, despite this seemingly being popular and innocuous. The controversies, as well as guidelines if available, for each type of filter, are discussed. The review aims to rationalize the place of various filters in the anaesthesia and intensive care environment.     

Echocardiography in cardiac anaesthesia and intensive care

Echocardiography or cardiac ultrasound has long been established as an important cardiac imaging technique for acquiring real-time information about cardiac anatomy and function. The technological aspect of this cardiac ultrasound platform continues to evolve, recent developments such as real-time 3D scanning are currently being assimilated into clinical practice first in transthoracic scanning and now in transoesophageal scanning. Echocardiography use is migrating across patient populations and different specialities – there is currently much discussion on how best to adopt the technique for the general intensive care unit. Cardiac assessment and monitoring have always been an essential part of the management of the patient undergoing cardiac surgery and cardiothoracic intensive care (CTICU). Echocardiography additionally gives a diagnostic benefit and provides an immediate point of care assessment of surgical procedures. High quality training programmes are essential for the recognition and acceptance of the anaesthetist or intensivist echocardiographer. This review covers the more recent clinical aspects, training issues, technological advances and future developments in relation to these areas.     

Transoesophageal echocardiography in cardiac anaesthesia and intensive care

Transoesophageal echocardiography (TOE) is being increasingly used throughout the field of anaesthesia and intensive care and nowhere has its impact been greater than in cardiac practice. This article outlines the main uses for TOE in current practice and explores the different ways in which it may affect anaesthetic and surgical management. Use of TOE for diagnostic purposes includes the assessment of valvular and other pathologies as well as for the rapid diagnosis of acute hypotension. Its use as a monitor for ischaemia and haemodynamic disturbances is also discussed. The importance of training and quality assurance are examined from a user's perspective and lastly a glimpse into the future reveals the enticing prospect of real-time 3 dimensional cardiac imaging.     

Gastrointestinal problems in intensive care

Gastrointestinal issues are common in ICU and include both surgical and non-surgical problems. A high index of suspicion and regular clinical assessment are necessary due to inherent difficulties evaluating critically ill and ventilated patients. Gastrointestinal failure may complicate or even precipitate multi-organ failure with systemic inflammatory response due to bacterial translocation. Intra-abdominal hypertension can be under-recognized and causes renal failure and other complications. Although colonic pseudo-obstruction is often conservatively managed, early recognition and treatment can prevent perforation. Stress-related mucosal bleeding is common in ICU, but serious gastrointestinal haemorrhage is rare. Early enteral nutrition and H₂-receptor antagonists reduce the incidence of upper gastrointestinal bleeding in high-risk ICU patients. Although delayed bowel motions are the norm, lack of defecation may also occur. This does not necessarily equate to constipation and should only be treated if problems occur.     

Gastrointestinal problems in intensive care

Gastrointestinal issues are common in the ICU and include both surgical and non-surgical problems. A high index of suspicion and regular clinical assessment are necessary due to inherent difficulties evaluating critically ill and ventilated patients. Gastrointestinal failure may complicate or even precipitate multi-organ failure with systemic inflammatory response due to bacterial translocation. Intra-abdominal hypertension can be under-recognized and cause renal failure and other complications. Although colonic pseudo-obstruction is often conservatively managed, early recognition and treatment can prevent perforation. Stress-related mucosal bleeding is common in ICU, but serious gastrointestinal haemorrhage is rare. Early enteral nutrition and proton-pump inhibitors reduce the incidence of upper gastrointestinal bleeding in high-risk ICU patients. Although delayed bowel motions are not unexpected, lack of defecation may also occur. This does not necessarily equate to constipation and should only be treated if problems occur.