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.

This chapter explores some of the fundamental issues surrounding wound healing. It is important that perioperative practitioners understand the physiological process of wound healing as it plays a key role in the patient’s ability to maintain homeostasis and recover from surgery. A wound is any break in the continuity of the skin. Understanding the process of wound healing provides insight into understanding wound assessment and the choice of appropriate dressings and drains. The principles outlined in this chapter will apply equally to wounds caused by trauma, surgical incisions, intravenous cannulation, and invasive haemodynamic monitoring.

Surgery and general anaesthesia are invasive and inherently risky. A rarely discussed reality of perioperative care is that sometimes patients die during anaesthesia and surgery, and many perioperative practitioners are not suitably prepared to handle such an event and its aftermath. Despite the rarity of intraoperative deaths, the experiences of those involved show that there is the potential for a long-lasting impact on individuals and teams. This chapter summarises the incidence of intraoperative death, reviews the potential impact on perioperative practitioners, and explores the different approaches to navigate their aftermath.

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.