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In the February 2010 BJA …
British Journal of Anaesthesia 104 (1) (2010)
doi:10.1093/bja/aep394
IN THIS ISSUE
In the February 2010 BJA. . .
Desflurane and sevoflurane: the early recovery period
Opioid induced hyperalgesia Opioid induced hyperalgesia (OIH) is a paradoxical response to an opioid agonist, where instead of an analgesic, or antinociceptive effect occurring, there is an increase in pain perception. There are some laboratory based studies that have explored the basis of this clinical chronic pain problem and suggested possible mechanisms. Minville et al. ( pages 231 – 8) present findings that add further weight to the importance of the NMDA receptor in acute OIH. Their mouse model has the benefits of more closely mimicking the clinical situation than some previous models and, as such, their findings may be more directly translatable. The implications of these findings and an overview of the developments in this interesting field of research are addressed in the accompanying Editorial (Colvin and Fallon, pages 125 – 7).
PONV Scoring PONV occurs in around 30% of patients overall postoperatively but its severity ranges from being a minor inconvenience through to a serious postoperative complication. It would be of value to have a scoring system which can indentify clinically significant PONV at an early stage. To this end, Wengritzky et al. ( pages 158– 66) have developed and validated a PONV Intensity Scale. In the development phase the authors identified a number of key factors and followed this with a validation study. They conclude that this Scale is a valid, reliable, and responsive measure of clinically important PONV.
# 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]
Downloaded from http://bja.oxfordjournals.org/ at McGill University Libraries on November 21, 2013
Three studies in this month’s BJA look at different aspects of the early recovery period following desflurane or sevoflurane anaesthesia. Dahmani et al. ( pages 216– 23) have examined the effect on emergence agitation in children in a meta-analysis of studies using desflurane or sevoflurane. They found a protective effect for propofol, ketamine and fentanyl when used with these agents. The effects of desflurane or sevoflurane on early cognitive function in the elderly have been examined in a randomized study (Ro¨rtgen et al., pages 167– 74). The authors found no difference between the agents in overall incidence but assessment scores were achieved earlier with desflurane. The effect of desflurane or sevoflurane on the recovery of airway reflexes at the end of anaesthesia has been compared in patients in three different weight ranges (BMI 18– 24, 25 – 30 and .30) (McKay et al., pages 175 – 82). They found that prolonged anaesthesia and greater BMI delayed airway reflex recovery and this was more pronounced after sevoflurane than desflurane.
doi:10.1093/bja/aep394
IN THIS ISSUE
In the February 2010 BJA. . .
Desflurane and sevoflurane: the early recovery period
Opioid induced hyperalgesia Opioid induced hyperalgesia (OIH) is a paradoxical response to an opioid agonist, where instead of an analgesic, or antinociceptive effect occurring, there is an increase in pain perception. There are some laboratory based studies that have explored the basis of this clinical chronic pain problem and suggested possible mechanisms. Minville et al. ( pages 231 – 8) present findings that add further weight to the importance of the NMDA receptor in acute OIH. Their mouse model has the benefits of more closely mimicking the clinical situation than some previous models and, as such, their findings may be more directly translatable. The implications of these findings and an overview of the developments in this interesting field of research are addressed in the accompanying Editorial (Colvin and Fallon, pages 125 – 7).
PONV Scoring PONV occurs in around 30% of patients overall postoperatively but its severity ranges from being a minor inconvenience through to a serious postoperative complication. It would be of value to have a scoring system which can indentify clinically significant PONV at an early stage. To this end, Wengritzky et al. ( pages 158– 66) have developed and validated a PONV Intensity Scale. In the development phase the authors identified a number of key factors and followed this with a validation study. They conclude that this Scale is a valid, reliable, and responsive measure of clinically important PONV.
# 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]
Downloaded from http://bja.oxfordjournals.org/ at McGill University Libraries on November 21, 2013
Three studies in this month’s BJA look at different aspects of the early recovery period following desflurane or sevoflurane anaesthesia. Dahmani et al. ( pages 216– 23) have examined the effect on emergence agitation in children in a meta-analysis of studies using desflurane or sevoflurane. They found a protective effect for propofol, ketamine and fentanyl when used with these agents. The effects of desflurane or sevoflurane on early cognitive function in the elderly have been examined in a randomized study (Ro¨rtgen et al., pages 167– 74). The authors found no difference between the agents in overall incidence but assessment scores were achieved earlier with desflurane. The effect of desflurane or sevoflurane on the recovery of airway reflexes at the end of anaesthesia has been compared in patients in three different weight ranges (BMI 18– 24, 25 – 30 and .30) (McKay et al., pages 175 – 82). They found that prolonged anaesthesia and greater BMI delayed airway reflex recovery and this was more pronounced after sevoflurane than desflurane.