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Introduction: Danish anaesthesiology research has traditionally done well internationally. However, there are signs that the research activity is declining. The aim of this article is both to appraise the status of the development of research in anaesthesiology and to discuss the problems that face Danish anaesthesiology research., Material and Methods: The development of research is assessed from the bibliometric literature based on the number of publications in journals that use a peer review of the articles, the total international exposure, the absolute impact of citations, and finally the proportion of publications cited at least once., Results: Unlike countries with which we usually compare ourselves, both the total level of research activity and the amount of international exposure of research have been declining in Denmark over the past 10-15 years. However, the quality of the research appears to be improving., Conclusion: On the background of debates within the speciality--e.g. at various meetings and workshops--the author discusses the reasons for and impact of the declining level of research activity. An account is given for what is being done within the speciality to promote research, and tangible proposals are put forward with a view to promoting research activity further at different levels in the Danish Health Service. Finally, attention is drawn to the three most important challenges facing Danish anaesthesiology research in the coming years, namely the shortage of specialist practitioners, the new medical paradigm shift, and the bibliometric methods used for research evaluation.

For more than 20 years, the Danish Cholinesterase Research Unit (DCRU) has collected information about patients showing an abnormal response to succinylcholine. The purpose of this study was to evaluate our clinical findings in patients referred because of prolonged response following succinylcholine. Also, we wanted to evaluate the results of our prospective controlled studies of the effect of succinylcholine in patients with normal and abnormal plasma cholinesterase genotypes. An explanation for the apparent abnormal response to succinylcholine was only found in roughly 60% of the 1247 patients referred to the Unit. In the remaining nearly 40% of the patients the reason for the abnormal response remained obscure, though our results indicate that the anaesthetic technique, including hyperventilation or central respiratory depression, was most likely to be the reason. The significance of the different genotypes, including two newly discovered genotypes (AK, AH), for the reaction to succinylcholine was evaluated and found to be comparable to previous findings. Our results indicate that it is a problem for many anaesthetists to correctly diagnose a prolonged response to succinylcholine. We therefore urge the anaesthetist to use a peripheral nerve stimulator when faced with a case of apparent abnormal response to succinylcholine.

Bambuterol, a carbamate ester prodrug of the bronchodilator terbutaline, was tested as inhibitor and substrate of human serum cholinesterases of the genotypes EuEu (the normal enzyme), EaEa (the atypical enzyme) and EuEa. The IC50 for the normal enzyme was 11 +/- 2.2 nM (mean, SD, N = 10) and for the atypical enzyme 140 +/- 6 nM (N = 13), indicating a much higher affinity of bambuterol to the normal enzyme. The heterozygotes showed a mixed behaviour; the major activity was inhibited like the normal enzyme (IC50 = 9.3 +/- 1.9 nM, N = 9), while a residual activity (10-15%) was inhibited by bambuterol like the atypical enzyme. At a bambuterol concentration of 100 nM each of the three cholinesterase genotypes responded uniquely to bambuterol; the normal enzyme was inhibited to 2.2 +/- 0.9%, the atypical enzyme to 58 +/- 4.6%, and the heterozygote to 10 +/- 1.2% of the basal activity. Bambuterol may therefore be added to the list of inhibitors useful in the genotyping of cholinesterases. Bambuterol was much less efficiently hydrolysed in serum containing the atypical cholinesterase than in serum containing the normal enzyme. The results of the hydrolysis experiments once again illustrate the difference in affinity of bambuterol to the genetic forms of cholinesterase, and also strengthen the evidence that cholinesterase is the major serum enzyme catalysing the hydrolysis of bambuterol.

Five lactating women who underwent surgery and were treated with morphine epidurally or IV/IM in the postoperative phase were included in the study. The morphine concentrations in plasma and breast milk were determined 0, 15, 30, 45, 60, 90, 120, 240, 360 and 480 min after drug administration by means of a specific radioimmunoassay for morphine. The milk-to-plasma ratio was 2.45 +/- 0.8 (mean +/- s.d.). The amount of morphine transferred by nursing is, even at the peak concentration of 500 ng/ml milk, small and will hardly cause respiratory depression or drowsiness in the child.