Although previously considered entirely reversible, general anaesthesia is now being viewed as a potentially significant risk to cognitive performance at both extremes of age. A large body of preclinical as well as some retrospective clinical evidence suggest that exposure to general anaesthesia could be detrimental to cognitive development in young subjects, and might also contribute to accelerated cognitive decline in the elderly. A group of experts in anaesthetic neuropharmacology and neurotoxicity convened in Salzburg, Austria for the BJA Salzburg Seminar on Anaesthetic Neurotoxicity and Neuroplasticity. This focused workshop was sponsored by the British Journal of Anaesthesia to review and critically assess currently available evidence from animal and human studies, and to consider the direction of future research. It was concluded that mounting evidence from preclinical studies reveals general anaesthetics to be powerful modulators of neuronal development and function, which could contribute to detrimental behavioural outcomes. However, definitive clinical data remain elusive. Since general anaesthesia often cannot be avoided regardless of patient age, it is important to understand the complex mechanisms and effects involved in anaesthesia-induced neurotoxicity, and to develop strategies for avoiding or limiting potential brain injury through evidence-based approaches.
anaesthesia, general; anaesthetics; cognitive disorder; neurotoxicity syndromes; postoperative complications
To evaluate the antiemetic efficacy of ondansetron, metoclopramide or small dose of propofol following ear, nose and throat (ENT) surgery.
Materials and methods
A prospective randomized study involving 60 patients, both children and adults undergoing elective ENT surgery under standard general anesthesia. At the completion of surgery the patients received either 0.1 mg/kg of ondansetron or 0.2 mg/kg of metoclopramide or 0.5 mg/kg of propofol intravenously. The patients were observed for 24 hrs after operation for any occurrence of nausea and vomiting.
The incidence of postoperative nausea and vomiting (PONV) during first 24 hrs was recorded in 20%, 70%, 50% of patients who had received ondansetron, metoclopr-amide or propofol respectively (p < 0.05). Fewer patients given ondansetron needed rescue antiemetic. The incidence of PONV was higher following middle year surgery.
It was concluded that ondansetron was most effective in preventing occurrence of PONV while metoclopramide was least effective. Propofol was effective only in 50% of patients, thus not recommended for routine use.
Postoperative nausea and vomiting; Ear, nose and throat surgery; Ondansetron; Metoclopramide; Propofol
Management of the difficult airway in an infant is a challenge for the anesthesiologist. A 10-month-old infant presented to an otolaryngologist with nasopharyngeal mass since birth, which had increased rapidly in size in the last 1 month and was hanging through the cleft palate into the oropharynx. The infant was scheduled for excision of the nasopharyngeal mass through a maxillary approach and the tongue mass through an oral approach under general anesthesia. This case report describes endotracheal intubation performed successfully under sedation and local anesthesia in an infant with a nasal mass protruding through the cleft palate into the oropharynx.
Pediatric airway; difficult airway; pediatric intubation
Children with craniofacial abnormalities provide a challenge to an anesthesiologist being one the commonest cause of expected difficult airway. Difficult airway management should be predicted and planned in advance to avoid critical problems. It is important to understand the development and characteristics of the more common anomalies and their peculiar anesthetic challenges in order to construct a safe anesthetic plan. We describe the successful airway management of a Tessier N. 4 anomalous child with left orofacial cleft, cleft lip and cleft palate.
Cleft surgery; difficult airway; orofacial clefts; Tessier N. 4 cleft
Gelofusine (which does not contain calcium) has a greater effect on coagulation than Haemaccel (which contains 6.25 mmol/l of calcium). This in vitro study was performed to assess whether calcium might be the cause of the different effects on coagulation.
Three solutions were compared; (a) Gelofusine, (b) Gelofusine with calcium added to 6.25 mmol/l, and (c) Haemaccel. Thromboelastography (Sonoclot) was used to examine whole blood coagulation, with time to peak clot weight as the primary outcome measure.
There was no significant difference between the Gelofusine containing solutions. Both Gelofusine solutions gave a greater impairment of coagulation than the Haemaccel solution.
The different effect of Gelofusine on coagulation compared with Haemaccel does not seem to be related to the different calcium contents of the solutions.
resuscitation; blood coagulation; succinylated gelatin; polygeline; fluid therapy
Postpartum hemorrhage is leading cause of maternal mortality and still remains a challenging condition to treat and hysterectomy may be required to control the bleeding once medical interventions fail. These strategies are not always successful and a direct approach in activating the coagulation system can be more effective and life saving. We describe here the mechanism of action of rFVIIa, review of literature and its use in 10 cases with different causes for PPH with good response.
PPH; Hemorrhage; rFVIIa; Coagulation; Bleeding; NICE registry; NovoSeven