Letters

Fast track admission for children with sickle cell crises

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7135.934 (Published 21 March 1998) Cite this as: BMJ 1998;316:934

Should morphine or pethidine be given?

  1. Peter Daggett, Consultant physician
  1. Staffordshire General Hospital, Stafford ST16 3SA
  2. Haematology Department, Whittington Hospital, London N19 5NF
  3. Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston 7, Jamaica
  4. North Middlesex Hospital, London N18 1QX

    EDITOR—Davies and Oni's review of the management of sickle cell disease1 was published in the same issue of the BMJ as the evaluation by Fertleman et al of a fast track admission policy for children with sickle cell crises.2 The review is based on the practice at the Central Middlesex Hospital, where pethidine has been associated with fits, and morphine is the preferred analgesic.1 At the North Middlesex Hospital, only a few miles away, pethidine is evidently preferred in children.2 Was this difference of approach noted by the editorial staff? Which group is right?

    References

    1. 1.
    2. 2.

    Opiates other than pethidine are better

    1. S D'Sa, Specialist registrar in haematology,
    2. N Parker, Consultant haematologist
    1. Staffordshire General Hospital, Stafford ST16 3SA
    2. Haematology Department, Whittington Hospital, London N19 5NF
    3. Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston 7, Jamaica
    4. North Middlesex Hospital, London N18 1QX

      EDITOR—We applaud the fast track admission policy for children with sickle cell crises that has been set up by Fertleman et al at the North Middlesex Hospital.1 We fully agree that early delivery of adequate analgesia by specialised staff should be the objective of all units managing acute sickle crises.

      However, we disagree with the choice of pethidine. While being an effective analgesic, pethidine is a well documented cause of unpredictable neurotoxicity, …

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