Brain

P. Simpson

The mini-symposium in this issue returns to the subject of the central nervous system. The reviews are all related to areas where significant advances have occurred or where the subjects are particularly topical. Although the earlier ‘brain’ mini-symposium considered anaesthesia for intracranial surgery in general, this issue contains a specific review of the particular issues related to anaesthesia for cerebro- vascular and aneurism surgery.

The scope of the articles has been broadened to include the particular problems associated with anaesthesia for surgery of the cervical spine, both electively and in the emergency situation. With the increasing number of patients successfully resus- citated after major trauma, early surgery for fixation of unstable neck fractures is becoming increasingly important. Also included is a review of the particular problems associated with elective surgery in severe

disease of the cervical spine, both in rheumatoid arthritis and also other related conditions.

With the increasing emphasis on high dependency units and 24 h recovery facilities, the specific post- operative problems associated with neurosurgical patients are considered, including monitoring, sedation, analgesia and the control of fitting. The measurement and manipulation of intracranial pressure, together with its importance in the treat- ment both of postoperative and head-injured patients is also reviewed extensively in a specific article. Finally, but again very important, particularly with the emphasis on European standardisation, the diag- nosis and management of brain-stem death in neuro- surgical patients is discussed. The subsequent care of a potential organ donor will be considered in a future issue.

Dr Peter Simpson, Frenchay Hospital, Bristol BS16 ILE. UK

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