In anesthesiology and critical care medicine, specific arterial blood pressure targets should be attained, depending on the setting. For instance, a growing body of evidence indicates that perioperative blood pressure should not markedly deviate from its usual level. This underscores the importance of blood pressure measurement, ideally non-invasively, and has therefore spurred intense research efforts . Recent advances in non-invasive blood pressure monitoring are noteworthy. They involve not only innovative technologies such as the automatic finger cuff but also the widely used automatic upper arm cuff. The present chapter aims at providing a state of the art of non-invasive blood pressure monitoring in adult patients in acute care settings with emphasis on recent advances. This chapter addresses several key issues such as “are non-invasive measurements of blood pressure true and accurate?”, “can non-invasive monitoring detect changes in blood pressure? ” and “what if the patient is obese and / or has cardiac arrhythmia?”

This chapter explores the beginning of the end of the emotional regime of Romantic sensibility and the origins of surgical scientific modernity. It illuminates this crucial period of transition through the juxtaposition of two distinct but conceptually and ideologically intertwined moments in surgical history. These are, firstly, the debates surrounding the practice of anatomical dissection that came to the fore in the 1820s and culminated in the passage of the Anatomy Act in 1832, and, secondly, the introduction and early use of inhalation anaesthesia in the later 1840s. In both instances it highlights the powerful influence of utilitarian thought in divesting the body, both as object and subject, of emotional meaning and agency. In the former instance it demonstrates how an ultra-rationalist understanding of sentiment was set in opposition to popular ‘sentimentalism’ in order to divest the dead bodies of the poor of emotional value. Meanwhile, in the latter, it considers how the emotional subjectivity of the newly anaesthetised patient was swiftly tamed by the operations of a techno-scientific rationale.

This chapter explores some of the new roles that have been introduced into perioperative care over the last couple of decades. These are the surgical first assistant, surgical care practitioner, and anaesthetic associate. It highlights the history, educational pathways, role boundaries, scope of practice, and the professional and legal implications of each of the extended or advanced roles.

The conduct of a general anaesthetic is more than just the administration of a drug to induce anaesthesia – a wide variety of agents are available, and they can be used pre-, intra-, and postoperatively. They will also be used for different purposes in different situations. This chapter discusses many of the common drugs used during a general anaesthetic, with a brief description of the effects, mechanism of action, and different routes of administration.

Regional anaesthesia is the use of local anaesthetic drugs to block sensations of pain from a large area of the body. It is used to allow surgery to proceed either without general anaesthesia or combined with general anaesthesia to provide superior pain relief than can be achieved with analgesic drugs alone. It is broadly divided into two categories. Neuraxial blocks involve injection of local anaesthetic close to the spinal cord, such as in the subarachnoid (intrathecal) space (known as a spinal) or in the epidural space (known as an epidural). Peripheral nerve blocks involve injection of local anaesthetic near peripheral nerves or plexuses. This can be performed either using landmark technique, a nerve stimulator, or with ultrasound guidance depending on the chosen block. Common equipment and techniques used to perform regional anaesthesia are discussed in this chapter, as well as advantages, potential risks, and the patient preparation and monitoring that is required.

This chapter discusses the management of obstetric patients undergoing anaesthesia and surgery. First, it outlines the distinct challenges of emergency obstetric anaesthesia and surgery. Second, it discusses pregnancy related changes to anatomy and physiology, common obstetric procedures, and drugs specific to the obstetric speciality. Finally, it highlights the advancements in care and medical technology and draws upon some of the moral and legal dilemmas faced by multidisciplinary teams in the obstetric setting.

This chapter explains the fundamentals of basic patient monitoring for patients undergoing general anaesthesia. Monitoring provides information and feedback of a patient’s physiological state in response to any therapeutic interventions or stimuli during anaesthesia and surgery. It is vital that perioperative practitioners understand the underlying principles of basic patient monitoring. This includes understanding how and what is being measured, how the monitoring is assembled, and how to problem solve to ensure optimal functionality and accuracy.

This chapter explains the challenges involved with bariatric surgery and how they can be navigated to optimise patient care. Due to the increasing global rates of obesity, increasing numbers of bariatric patients are presenting for surgery. Obesity is associated with several physiological and psychological effects, and it is essential that these are considered in order to plan and deliver safe, effective, patient-centred perioperative care.

Since initial experiments with nitrous oxide and ether in the nineteenth century, general anaesthesia has been near synonymous with inhaled agents. However, total intravenous anaesthesia may offer advantages in certain circumstances. Total intravenous anaesthesia can be defined as the induction and maintenance of general anaesthesia using agents given solely intravenously and in the absence of all inhalational agents including nitrous oxide. It may be necessary when volatile anaesthesia is contraindicated or infeasible or may be chosen for other benefits. This chapter provides an overview of the benefits and disadvantages of total intravenous anaesthesia, as well as describing the equipment and care required to use it safely.

In the immediate post-anaesthesia phase the patient’s airway, breathing, and circulation are subject to dynamic change as the effects of anaesthesia begin to wear off. If not carefully managed, life threatening complications can occur rapidly. The experienced practitioner uses risk appraisal to inform physical assessment in order to pre-empt complications or correct them if they occur. This chapter focuses on the key priorities of assessment together with other essential factors such as pain control.

This chapter is written for practitioners working within the perioperative environment that require an understanding of how to assess and manage a patient’s airway. An introduction to airway anatomy highlights relevant anatomical landmarks, and a number of techniques that can be employed for both basic and advanced airway management are described. Airway equipment used by the anaesthetic practitioner will vary depending on requirements of the patient and procedure. Therefore, an overview of both standard and specialist airway equipment available, and how this is used to establish and maintain a patent airway, is provided.

This chapter focuses on the perioperative care of the paediatric patient and aims to undermine the common misconception that children are just little adults. Providing safe and effective care for children requires a clear underpinning knowledge of their unique needs. Conscious consideration of age-dependent characteristics such as anatomical, physiological, psychological, and behavioural are essential in the delivery of paediatric patient care. The rationale for adaptations to the delivery of care is to ensure children receive anaesthesia and surgery in a safe and appropriate environment.

Anaesthetic breathing systems are used to deliver oxygen and anaesthetic gases to patients and remove carbon dioxide. A breathing system is most commonly attached to an anaesthetic machine, which is designed to deliver the fresh gas flow to the patient via a facemask, a supraglottic device or an endotracheal tube. The breathing system used can affect the composition of the gas and volatile anaesthetic mixture inhaled by the patient, and so it is important to understand the different breathing systems used in anaesthesia. This chapter describes the key components of the different breathing systems and explores the benefits and disadvantages of the circuits in the Mapleson classification.

The primary purpose of the anaesthetic machine is to deliver anaesthetic gases and volatile agents safely to the patient - helping to maintain a suitable level of consciousness and analgesia for surgery. It is vital that any clinician checking and using an anaesthetic machine is familiar with the type of machine they are intending to use and possess a detailed knowledge of how it operates. Machines must be rigorously checked and tested by a suitably trained person before use and a breathing circuit check should take place between each patient. This chapter is an introduction to the anaesthetic machine, highlighting the main components and features that are essential to maintaining user and patient safety.