In the June 2008 BJA ...
Non-heart beating organ donation The advances in transplant medicine have led to an increased need for organ donation which has not been matched with an increase in organ availability. The use of non-heart beating organ donation (NHBOD) is a potential (partial) solution to this. It is being used increasingly in the UK, and is more extensively used in other countries. In this issue, the successful implementation of a NHBOD programme to a neurosciences ICU is described (Thomas et al., pages 820–6). However, the logistic and ethical questions raised by NHBOD are complex and are not yet resolved. The accompanying editorials (Smith and Murphy pages 735–7 and Bell pages 738–41), present the arguments both for and against the use of NHBOD. This is an important and on-going issue and readers are invited to contribute to the discussion of this subject by e-letter (http://bja.oxfordjournals.org.uk-click on the article or editorial then on E-letters). Views from countries where this is more widely used would be welcome.Cellular effects of sepsis We are all familiar with the systemic cardiovascular effects of sepsis. However, there is a major research interest in the microvascular and cellular mechanisms which initiate the systemic changes. Characterization of these changes in response to sepsis should lead ultimately to new therapeutic options. Three studies in this issue have explored different aspects of these mechanisms. At an early stage of sepsis, there are changes in microvascular vessel diameter and reactivity, and then leucocyte adhesion and migration occurs. Aspects of these processes have been studied in vitro using the leucocyte-attractant, endogenous peptide LL-37 (Berkestedt et al., pages 803–9), which produced endothelial relaxation, and in response to lipopolysaccharide (LPS) stimulation (Galley et al., pages 815–19), activated protein C decreased neutrophil chemotaxis and Il-6 release. Measurement of the concentrations of the vasoactive peptides nociceptin and urotensin-II in the plasma of patients with sepsis (Williams et al., pages 810–14) found raised nociceptin in a sub-group of patients who had undergone gastrointestinal surgery.
Memory and awareness during anaesthesia The BJA is pleased to publish the abstracts of the recent 7th MAA meeting (pages 868–80P). Prevention of awareness during anaesthesia and the goal of a depth-of-anaesthesia monitor are high priorities for anaesthetists. Both these issues are addressed in the abstracts which cover subjects ranging from pharmacology through imaging to signal processing. The abstracts are accompanied by an Editorial (Sneyd and Matthews, pages 742–4) that not only provides an overview of the meeting but also discusses the recent B-unaware study. The Editorial's important conclusion from the B-unaware study is that we have options which can minimize the risk, but doing nothing is not an option.
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