Effects of cholestasis and hyperammonemia on dendritic spine density and turnover in rat hippocampal neurons.

Adults and children with cholestatic liver disease are at risk for type C hepatic encephalopathy (HE) and may present lifelong neurocognitive impairment. While the underlying cellular and molecular mechanisms are still incompletely understood, ammonium and bile acids (BAs) seem to play a key role in this pathology, by crossing the blood-brain-barrier and modifying neuronal homeostasis and synaptic plasticity. This experimental study aimed to investigate the effects of ammonium and BAs on dendritic spines of rat hippocampal CA1 neurons.

Dexmedetomidine in paediatric anaesthesia: a call for action?

Dexmedetomidine is increasingly used in paediatric anaesthesia practice. In this issue of the British Journal of Anaesthesia, a retrospective hospital registry study in anaesthetised children showed that intraoperative use of dexmedetomidine was dose-dependently associated with a longer postanaesthesia care unit length of stay. Dexmedetomidine administration was also associated with higher total hospital costs and higher odds of unwarranted haemodynamic effects, while the onset of emergence delirium was not reduced.

Developmental anaesthesia neurotoxicity in humans: finding the sweet spot?

A recent human epidemiological study in this issue of British Journal of Anaesthesia examined the association between anaesthesia exposure in pregnant women undergoing appendicectomy or cholecystectomy and the subsequent diagnosis of behavioural disorders in their offspring. When compared with unexposed children, prenatally exposed children had ∼30% greater likelihood of a diagnosis of disruptive or internalising behavioural disorders. Although these data are new and interesting, they should be interpreted with caution.