Anaesthesia for ICU-based procedures: the advantages of and options available for inhalational anaesthesia

Abstract

Many patients admitted to an intensive care unit (ICU) will undergo a surgical procedure for correcting the underlying cause of their disease, to deal with the complications of their disease or the treatment of their disease, or to undergo diagnostic procedures which will direct the course of their treatment. The majority of these procedures are performed in the operating theatre, but a small number of these cases will be managed in the ICU environment, which will place the anaesthetic and surgical team in an unfamiliar environment.

Many studies indicate that the outcomes of these procedures depend on the interaction of many factors, which include the extent of the procedure, the physiologic reserve of the patient, the presence of chronic pathological conditions, and the nature of the acute physiological derangements. The plan for the critically ill patient should include preoperative optimisation of the general condition, a chronological plan for the intraoperative treatment, coordination with the surgical team, provision for additional equipment, expertise and resources, and a postoperative plan.

In this discussion, we shall put emphasis on the anaesthetic options, techniques and problems that we experience with the anaesthesia for procedures which will be performed in ICU.