December 28, 2011

Fluid responsiveness

The use of goal-directed fluid therapy (GDT) in the management of patients undergoing major surgery is controversial. A randomized controlled study of 179 anaerobically ‘fit or unfit’ patients undergoing colorectal surgery, (Challand et al., pages 53–62) compared standard and GDT fluid management and found no advantage for GDT. In contrast, a study in 50 neonates and infants found transoesophageal Doppler was useful in predicting fluid responsiveness (Raux et al., pages 100–7). A study of the effects of propofol of the mechanisms involved in dilation of cerebral arterioles (Hama-Tomioka et al., pages 21–9) found that propofol has significant effects which may have clinical relevance. Cardiopulmonary exercise testing (CPET) is used to stratify risk preoperatively and to determine intraoperative fluid management strategy. Comparison of CPET and a 6-min walk test in 110 patients found reasonable correlation between the two methods (Sinclair et al., pages 30–5).

Paediatric anaesthesia

Several import aspects of paediatric anaesthesia are investigated in articles in this month’s BJA. Paediatric cardiomyopathy is considered in a review article (Ing et al., pages 4–12). This describes the incidence and types and proposes anaesthetic management strategies. Standard coagulation testing and the use of ROTEM^® were compared in paediatric surgical patients by Haas et al. (pages 36–41) who found that overall they did not correlate well but that further work was needed. Remote measurement of leak around an uncuffed tracheal tube was examined in a study which progressed from lab-based simulation through to evaluation in 135 infants in ICU (Sims et al., pages 152–8). A useful objective measurement was obtained. Finally, a case report describes the development, diagnosis and treatment of opioid-induced hyperalgesia in an infant who underwent multiple surgical procedures (Hallet and Chalkiadis, pages 116–18).

Research priorities in anaesthesia

Anaesthesia can find it difficult to compete at a national/international level for research funding, particularly in the current setting of limited public resources. This may, in part, come from the perception that it is essentially ‘safe’ and hence lower priority than other, higher profile, disciplines. There are, however, still many important clinical and basic science aspects in which research in anaesthesia can play a vital part. In the UK, this subject has been addressed by the National Institute of Academic Anaesthesia (NIAA), which commissioned a research priority setting exercise. The process and its findings are described in an article by Howell et al. (pages 42–52). While this was UK-based, its methodology and outcome have a wider international applicability. These aspects are discussed in an accompanying Editorial (Mahajan and Reilly, pages 1–3).

Organ Donation Supplement

I would like to draw all readers’ attention to the supplement on Organ Donation that accompanies this issue of the BJA. This collection of articles, which has been produced in collaboration with the UK Organ Donation Taskforce, covers the current scientific, clinical, legal, ethical and practical aspects of organ donation. Given the importance of a multidisciplinary approach to this important subject, I suggest that readers may wish to recommend this collection to their medical, nursing and non-medical colleagues.