In the November 2008 BJA...
Anaesthesia and analgesia in childrenThere have been considerable advances in paediatric anaesthesia in the past 20 years. The Review Article in this month's BJA (Sanders et al., pages 597–609) focuses on pre-clinical work on the effects of anaesthesia and analgesia on the developing brain. This article addresses aspects of neuroprotection and neurotoxicity which will be of interest and relevance to all anaesthetists, not just those who work in paediatrics. The pharmacology of morphine in neonates is described in a study by Anand and colleagues (pages 680–9) which shows the maturation of morphine metabolism. A novel method of placing and securing a bronchial blocker in small children is described by Ho and co-workers (pages 690–3).
Spinal anaesthesia for surgery
Spinal (intrathecal) anaesthesia is used widely for surgical procedures. Three articles in this month's BJA address various aspects of its use. In a randomized study comparing hyperbaric bupivacaine, laevobupivacaine and ropivacaine (Luck et al., pages 705–10), a similar onset time and level of spread was found with the three agents. There was a quicker recovery from motor block in the ropivacaine group. The pruritis associated with the use of intrathecal morphine may be due to activation of the serotonergic system. Mirtazapine, a 5HT3 and 5HT2 antagonist, given preoperatively reduced the incidence of pruritis in a group of patients receiving spinal anaesthesia with bupivacaine and morphine (Sheen et al., pages 711–15). A laboratory study (Umbrain et al., pages 716–22) found that intrathecal lidocaine produces an increase in prostaglandin E2 in the CSF.
Intubation/Extubation and the cervical spine
Tracheal intubation in a patient with cervical spine immobilization can be a difficult and stressful procedure. Malik and colleagues (pages 723–30) have compared three of the new laryngoscopes with a standard Macintosh blade. They found that the new instruments, in general, required longer to complete intubation but provided a better view. A different aspect of cervical spine movement is investigated in a study of coughing on extubation at the end of cervical spine surgery (Hans et al., pages 731–37). The incidence was, as would be expected, higher in smokers than in non-smokers but, interestingly, was lower in patients who had propofol anaesthesia than in those who had sevoflurane.
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Related articles in BJA:
- Balancing paediatric anaesthesia: preclinical insights into analgesia, hypnosis, neuroprotection, and neurotoxicity
- R. D. Sanders, D. Ma, P. Brooks, and M. Maze
BJA 2008 101: 597-609.[Abstract] [Full Text] - Morphine pharmacokinetics and pharmacodynamics in preterm and term neonates: secondary results from the NEOPAIN trial
- K. J. S. Anand, B. J. Anderson, N. H. G. Holford, R. W. Hall, T. Young, B. Shephard, N. S. Desai, B. A. Barton, and for the NEOPAIN Trial Investigators Group
BJA 2008 101: 680-689.[Abstract] [Full Text] - Placing the tip of the endotracheal tube at the carina and passing the endobronchial blocker through the Murphy eye may reduce the risk of blocker retrograde dislodgement during one-lung anaesthesia in small children
- A. M.-H. Ho, M. K. Karmakar, L. A. H. Critchley, S. K. Ng, and C.-Y. Wat
BJA 2008 101: 690-693.[Abstract] [Full Text] - Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine
- J. F. Luck, P. D. W. Fettes, and J. A. W. Wildsmith
BJA 2008 101: 705-710.[Abstract] [Full Text] - Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus
- M. J. Sheen, S.-T. Ho, C.-H. Lee, Y.-C. Tsung, F.-L. Chang, and S.-T. Huang
BJA 2008 101: 711-715.[Abstract] [Full Text] - Intrathecal lidocaine elevates prostaglandin E2 levels in cerebrospinal fluid: a microdialysis study in freely moving rats
- V. Umbrain, L. Shi, M.-H. Lauwers, I. Smolders, Y. Michotte, and F. Camu
BJA 2008 101: 716-722.[Abstract] [Full Text] - Comparison of Macintosh, Truview EVO2®, Glidescope®, and Airwayscope® laryngoscope use in patients with cervical spine immobilization
- M. A. Malik, C. H. Maharaj, B. H. Harte, and J. G. Laffey
BJA 2008 101: 723-730.[Abstract] [Full Text] - Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery
- P. Hans, H. Marechal, and V. Bonhomme
BJA 2008 101: 731-737.[Abstract] [Full Text]
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