Fundamentals of Anesthesiology and Critical Care Series

Posted on September 14, 2025 by Pat Neligan

Here are the first 9 Tutorials in the Series – the majority are useful for Anesthesiologists and Intensive Care practitioners. Every tutorial contains something that you may not have previously known: I guarantee, who ever you are, that you’ll learn something.

Tutorial 1: Saturated Vapor Pressure

Tutorial 2: The Gas Laws

Tutorial 3: Mixtures of Gases

Tutorial 4: The Alveolar Gas Equation

Tutorial 5: Henry’s Law

Tutorial 6: Carbon Dioxide Solubility

Tutorial 7: Oxygen Solubility

Tutorial 8: Oxygen Content of Blood

Tutorial 9: Oxyhemoglobin Dissociation

Clinical Forum – Western Anaesthesia Symposium 2025

Posted on June 16, 2025 by Pat Neligan

Here is a presentation that I gave at WAS in April – looking at the best papers that had been published in Critical Care up to that point in 2024-25.

A SHORT COURSE ON LOCAL ANESTHETICS

Posted on May 28, 2025 by Pat Neligan

I published 3 tutorials on Local Anesthetics this Month. These are part of a new series of Anesthesiology Tutorials.

Tutorial 1 looks at the basic pharmacology of local anesthetics

Tutorial 2 looks at the various different drugs that we use, the volume and concentration. I discuss the maximum safe doses at the end of the tutorial.

Tutorial 3 looks at the history of, the diagnosis of and the treatment of Local Anesthetic Systemic Toxicity (LAST)

Metabolic Acidosis in 2025 – More Important than Ever!

Posted on May 28, 2025 by Pat Neligan

This is a longer version of the lecture that I delivered at the 2025 College of Anaesthesiologists of Ireland Annual Scientific Meeting.

Nutrition 3 – Timing and Route of Nutrition in ICU

Posted on March 19, 2025 by Pat Neligan

This HI-Impact tutorial looks at the common questions relating to commencement and route of nutrition in critical care. Is TPN good, bad or indifferent. Is enteral feed better than parenteral? When should we start feeding? Is it useful to add parenteral feed to enteral if the patients’ caloric goals have not been met? When should patients achieve their isocaloric goals. I guarantee you’ll learn something.

Methanol Poisoning

Posted on December 12, 2024 by Pat Neligan

In November 2024 six tourists died of suspected Methanol Poisoning in Laos, and several more were hospitalized. Methanol, or methyl alcohol, is an industrial chemical used to thin paints, as a precursor for medley chemicals and for fuel cells. It is passed off as “vodka” (odorless, tasteless, clear) to unsuspecting victims.

Methanol is metaboized by the same pathways as ethanol, but to formaldehyde and formate. Although small amounts of methanol may be found in the body, due to gut bacterial fermentation, methanol poisoning is a life threatening problem. Formate causes a widened anion gap metabolic acidosis, blindness, brain damage and interferes with mitochondrial function resulting in cytotoxic hypoxia.

The treatment for methanol poisoning is fomipazole given 12 hourly intravenously, folate, intravenous fluids and, if necessary, renal replacement therapy. Fomipazole competitively antagonizes the metabolism of methanol by the enzyme alcohol dehyrogenase. If fomipazole is unavailable, ethanol can be given as an emergency measure, intravenously or orally.

HYPOVOLEMIC SHOCK

Posted on October 22, 2024 by Pat Neligan

Hypovolemic shock is one of the major problems we encounter in acute critical illness. This tutorial explains the mechanisms by which the body compensates for hemorrhage/hypovolemia, why the blood pressure and hemoglobin saturation are unhelpful and what tools may be useful at the bedside to assess the patient.

I also briefly discuss resuscitation of the bleeding patient and compartment syndromes.

HYPOTENSION AND SHOCK: Working the Problem

Posted on October 15, 2024 by Pat Neligan

This tutorial looks at the problems of Hypotension and Shock. I define the difference between the concepts – not all hypotensive patients are shocked and not all shocked patients are hypotensive. I then go through a system for exploring the hypotensive or shocked patients’ status to determine the underlying problem – illustrated by a series of clinical scenarios.

Cardiovascular Assessment 1: The Heart Rate

Posted on September 4, 2024 by Pat Neligan

This is the first tutorial in the cardiovascular assessment module. In the tutorial I discuss heart rate, how it originates and how it is controlled. This is principally a discussion about sinus bradycardia and sinus tachycardia. I go on to discuss the parasympathetic nervous system and the sympathetic nervous system, how they function physiologically and how they are impacted by drugs that we administer and disease processes. I provide a detailed discussion of adrenoceptor agonists and antagonists.

At Last – CHEST DRAINS!

Posted on August 21, 2024 by Pat Neligan

I feel like I have been working on this tutorial for several years. I actually have. When one encounters a modern chest drain unit in ICU for the first time or the 50th time it can be quite daunting. How much is draining? Is it oscillating? What does “bubbling” imply? When do you use suction? Why do some nurses leave a meniscus of fluid in the tubing but others don’t? What is the little red cap supposed to do?

This tutorial starts with a discussion of the physiology of pneumothorax and hemothorax, and then progressively visits one bottle, two bottle and three bottle systems. I then go on to explain how relatively modern chest drainage systems work, and how they need to be modified to apply suction – wet and dry. Finally I explain how very modern digital chest drainage systems work.

If you have struggled with understanding chest drains, I guarantee you’ll learn something.

ORtoICU

Tutorials in Anesthesiology & Intensive Care

Tag Archives: dr pat neligan galway