British Journal of Anaesthesia 104 (1) (2010)

doi:10.1093/bja/aep364

IN THIS ISSUE

In the January 2010 BJA

Postoperative pain
Several aspects of common postoperative pain problems are addressed in this issue of the British Journal of Anaesthesia. Pain following hip surgery done under spinal anaesthesia can be severe. Hwang et al. ( pages 89 93) have explored the use of an intraoperative i.v. infusion of magnesium sulphate in a randomized controlled comparison with a saline infusion. They found a signicant reduction in the postoperative PCA morphine requirements in the magnesium group. A new formulation combining acetaminophen and ibuprofen for pain relief following dental surgery was compared with the use of either drug alone (Merry et al., pages 80 8). Improved pain scores (AUC) were found with the combined drug over the 48-h study period. The risk of developing chronic pain following thoracotomy in children and young adults has been studied by Kristensen et al. ( pages 75 9). In a study of 88 patients who had thoracic surgery when aged 0 25yr, they found 14 with chronic pain. They conclude from their study that the pain is usually neuropathic in origin and is less likely to occur the younger the patient at the time of surgery.

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Ventilation strategies
Two aspects of lung ventilation are described in this issue. Elderly patients undergoing major abdominal surgery are a potentially high-risk group. Weingarten et al. ( pages 16 22) compared the use of a ventilatory strategy of recruitment, 6 ml kg21 tidal volume and 12 cm H2O PEEP with a conventional 10 ml kg21 and no PEEP technique in 40 patients .65 yr old. They found that the more aggressive strategy was tolerated haemodynamically and improved intraoperative oxygenation. This is a preliminary study and did not explore the effect on overall outcome. As anaesthetists, we all hope that we never have to use needle cricothyrotomy ventilation in an emergency. However, it can be a life-saving intervention. In a laboratory-based study, Lim and Benham ( pages 98 107) have examined the role of upper airways resistance in the ability of this technique to provide adequate lung ventilation.

The airway and intubation

Cricoid pressure is used widely during tracheal intubation. The recommended force required is often cited as 30 N. However, such force may cause distortion of the airway and hinder tracheal intubation. In a study in 30 children, Walker et al. ( pages 71 4) assessed the force require to produce a 50% compression of the airway and found a mean value of around 10 N. They propose that lower forces should be used in children. The Mallampati classication is often used as a preoperative screening for difcult intubation. Boutonnet et al. ( pages 67 70) examined the changes in Mallampati class in 87 pregnant patients in the peri-partum period. They found an increase in the number patients with Class 3 or 4 during labour and immediately after delivery.

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