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In the May 2010 BJA …
British Journal of Anaesthesia 104 (5) (2010)
doi:10.1093/bja/aeq083
IN THIS ISSUE
In the May 2010 BJA . . .
Ultrasound and nerve blocks The use of ultrasound in the placement of nerve blocks was introduced some 15 years ago. In that time there has been increasing interest in, and use of, ultrasound for placing nerve and plexus blocks. In the first of a two-part review, Marhofer et al. ( pages 538– 46) provide an overview of the technical advances, advantages and developments in this expanding field of anaesthetic activity. This activity is illustrated in two studies in this month’s issue. Stafford et al. ( pages 633 – 6) used ultrasound guidance to minimum volumes required to block each nerve in the brachial plexus. They found that only 2– 4 ml of local anaesthetic was required for each nerve. Greher et al. ( pages 637– 42), in a cadaver study, describe a new ultrasound approach to blocking the greater occipital nerve.
New formulations of propofol Propofol is used widely throughout the world for induction and maintenance of anaesthesia. However, it is not without adverse effects. There has been increasing interest in developing different formulations of propofol to try to overcome some of the problems associated with lipid solvent adverse effects. In this issue, the pharmacokinetics and dynamics of a new microemulsion formulation (Jung et al., pages 563 –76) were compared with those of the standard formulation in 288 patients. While the kinetics were essentially similar, the new formulation, unfortunately, caused more pain on injection. The current developments in this field are addressed in an accompanying Editorial (Egan, pages 533– 5) which provides an excellent summary of the various approaches to re-formulation of propofol. These include lipid-based emulsions (to reduce the total lipid content), non-lipid excipients (e.g., surfactants-co-surfactants, nano-particle carriers, cyclodextrins,) and a prodrug.
Preventing postoperative atelectasis Atelectasis of dependant lung units is common after general anaesthesia particularly when intermittent positive pressure ventilation (IPPV) has been used. Various lung recruitment manoeuvres, such as positive end expiratory pressure (PEEP) and continuous positive airway pressure (CPAP), have been proposed for reduction of atelectasis but their benefits have not been shown to persist postoperatively. In a prospective randomized study, Lumb et al. ( pages 643– 7) explored the efficacy of combining PEEP and CPAP at the end of anaesthesia and during extubation of the trachea. No persisting benefit accrued from these manoeuvres.
# The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
doi:10.1093/bja/aeq083
IN THIS ISSUE
In the May 2010 BJA . . .
Ultrasound and nerve blocks The use of ultrasound in the placement of nerve blocks was introduced some 15 years ago. In that time there has been increasing interest in, and use of, ultrasound for placing nerve and plexus blocks. In the first of a two-part review, Marhofer et al. ( pages 538– 46) provide an overview of the technical advances, advantages and developments in this expanding field of anaesthetic activity. This activity is illustrated in two studies in this month’s issue. Stafford et al. ( pages 633 – 6) used ultrasound guidance to minimum volumes required to block each nerve in the brachial plexus. They found that only 2– 4 ml of local anaesthetic was required for each nerve. Greher et al. ( pages 637– 42), in a cadaver study, describe a new ultrasound approach to blocking the greater occipital nerve.
New formulations of propofol Propofol is used widely throughout the world for induction and maintenance of anaesthesia. However, it is not without adverse effects. There has been increasing interest in developing different formulations of propofol to try to overcome some of the problems associated with lipid solvent adverse effects. In this issue, the pharmacokinetics and dynamics of a new microemulsion formulation (Jung et al., pages 563 –76) were compared with those of the standard formulation in 288 patients. While the kinetics were essentially similar, the new formulation, unfortunately, caused more pain on injection. The current developments in this field are addressed in an accompanying Editorial (Egan, pages 533– 5) which provides an excellent summary of the various approaches to re-formulation of propofol. These include lipid-based emulsions (to reduce the total lipid content), non-lipid excipients (e.g., surfactants-co-surfactants, nano-particle carriers, cyclodextrins,) and a prodrug.
Preventing postoperative atelectasis Atelectasis of dependant lung units is common after general anaesthesia particularly when intermittent positive pressure ventilation (IPPV) has been used. Various lung recruitment manoeuvres, such as positive end expiratory pressure (PEEP) and continuous positive airway pressure (CPAP), have been proposed for reduction of atelectasis but their benefits have not been shown to persist postoperatively. In a prospective randomized study, Lumb et al. ( pages 643– 7) explored the efficacy of combining PEEP and CPAP at the end of anaesthesia and during extubation of the trachea. No persisting benefit accrued from these manoeuvres.
# The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]