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BJA Advance Access originally published online on September 16, 2008
British Journal of Anaesthesia 2008 101(5):597-609; doi:10.1093/bja/aen263
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 BJA: November 2008
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Balancing paediatric anaesthesia: preclinical insights into analgesia, hypnosis, neuroprotection, and neurotoxicity

R. D. Sanders1,2,*,{dagger}, D. Ma1,{dagger}, P. Brooks2,{dagger} and M. Maze1,2,{dagger}

1 Department of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London
2 Magill Department of Anesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, Chelsea and Westminster Healthcare NHS Trust, London SW10 9NH, UK

* Corresponding author. E-mail: robert.sanders{at}ic.ac.uk

Logistical and ethical reasons make conducting clinical research in paediatric practice difficult, and therefore safe and efficacious advances are dependent on good preclinical research. For example, notable advances have been made in preclinical studies of pain processing that correlate well with patient data. Other areas of paediatric anaesthetic research remain in their infancy including mechanisms of anaesthesia and anaesthetic neuroprotection and neurotoxicity. Animal data have identified the potential ‘double-edged’ sword of administering anaesthetic agents in the young; although these agents can be neuroprotective in certain circumstances, they can be neurotoxic in others. The potential for this toxicity must be balanced against the importance of providing adequate anaesthesia for which there can be no compromise. We review the current state of preclinical research in paediatric anaesthesia and identify areas which require further exploration in order to provide the foundations for well-conducted clinical trials.

Keywords: anaesthesia, paediatric; analgesia, paediatric; complications, neurological; neuroprotection; pain, paediatric; sedation; toxicity, neurotoxicity

{dagger} Declaration of interest. R.D.S. conceptualized the review article, performed the literature search, and wrote the first draft. D.M., P.B., and M.M. advised on content and style of the article and read each draft. BOC and Air Products fund research in the authors' laboratory. M.M. and R.D.S. have acted as paid consultants for Air Liquide, France. M.M. has also received consultancy fees from Orion, Finland, and Hospira, USA.


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