British journal of anaesthesia
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The Centre for Perioperative Care (CPOC) has published in September 2022 guidance addressing perioperative anaemia. This editorial addresses the definition of anaemia for women and management of borderline anaemia in women. We also address implications of the CPOC guidance for anaesthetists and the future direction of anaemia research and management.
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Editorial Comment
Linking and unlinking the paediatric brain: age-invariant neural correlates of general anaesthesia.
There is no single electroencephalographic metric for general anaesthesia that is validated for both children and adults. This is, in part, because of the changing electroencephalographic features associated with development. Here, we discuss how alterations in correlated brain activity during general anaesthesia advance our understanding of anaesthetic monitoring and the neurobiology of consciousness.
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The dysfunction of the blood-brain barrier could contribute to the pathogenesis of the perioperative neurocognitive disorder. In a recent study published in the British Journal of Anaesthesia, Yang and colleagues developed an innovative microfluidics-assisted blood-brain barrier device to investigate the effects of neuroimmune interactions on blood-brain barrier opening. The findings are important and timely to understanding the mechanistic insights of perioperative neurocognitive disorder.
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Whilst the general presumption of the public is that general anaesthesia prevents awareness of any sensory stimuli, Lennertz and colleagues have shown in this issue of the British Journal of Anaesthesia that 11% of young adults were able to respond to auditory commands when neuromuscular blocking drugs were prevented from reaching one arm using the isolated forearm technique. This occurred with anaesthetic regimens that followed usual clinical practice in each of the 10 countries that enrolled patients, and it was significantly more common in women than in men. This high incidence demands attention. Further characterisation of the experience of these patients is essential to our understanding of the state of general anaesthesia.
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Editorial Comment
Assessment of haemostatic function in paediatric surgical patients: 'if you prick us, do we not bleed?'.
Healthy babies have ∼50% of adult procoagulant factor levels, but without an increased risk of bruising or bleeding. The preoperative clotting tests, prothrombin time and partial thromboplastin time, are frequently performed in infants and children. However, the clinical usefulness of screening coagulation tests remains controversial. ⋯ Enhanced coagulability was previously demonstrated on some viscoelastic testing devices using blood from younger infants. This editorial focuses on several key findings from the paediatric reference range study using a new whole blood viscoelastic coagulation test system, ClotPro® (Haemonetics, Boston, MA, USA). Altered clotting patterns in younger infants, underlying mechanisms of coagulation, and potential clinical implications are discussed.