Effective delivery of continuous renal replacement therapy (CRRT) depends on the longevity of the filter and circuit used in the CRRT machine. Safe and effective anticoagulation is crucial for maintaining the patency of these circuits. In children, heparin and citrate are the commonly used anticoagulants but they are limited by serious side effects and thus calls for meticulous monitoring. In conditions where neither of these can be used, prostacyclin can be an effective alternative. Prostacyclin is a platelet inhibitor that can be safely used as an efficient anticoagulant in CRRT. When combined with heparin, it induces a heparin-sparing effect, which can reduce the dosage and side effects of heparin. Furthermore, there is no need for performing time-consuming monitoring tests. Although prostacyclin seems to be an attractive option, there is scanty evidence about its use as an anticoagulant in CRRT in children. We review the evidence and practicalities, and propose a guideline for the use of prostacyclin as an anticoagulant in children requiring CRRT.

The preparation of two further NSN‐tris‐ethonium compounds, 9‐ethyl‐9‐thioniaheptadecylenebis(triethylammonium) triiodide (dioctasulphonium triethiodide; DOSE) and 11‐ethyl‐11‐thioniaheneicosylenebis(triethylammonium) triiodide (didecasulphonium triethiodide; DDSE) is described. The bis‐quaternary compound 7‐dioxothiatridecylenebis(triethylammonium iodide), and the NNN‐tris‐quaternary compounds 7:7‐diethyl‐7‐azoniatridecylenebis (triethylammonium) triiodide (dihexazonium triethiodide; DHAE), 9:9‐diethyl‐9‐azoniaheptadecylenebis(triethylammonium triiodide (dioctazonium triethiodide; DOAE) and 11:11‐diethyl‐11‐azoniahenicosylenebis(triethylammonium) triiodide (didecazonium triethiodide; DDAE) have also been synthesised. All the compounds possess neuromuscular blocking activity in the gastrocnemius muscle‐sciatic nerve preparation of the cat, the phrenic nerve‐diaphragm preparation of the rat and kitten and as measured by the rabbit head drop and mouse paralysis methods. Dihexazonium triethiodide and the sulphone 7‐dioxathiatridecylenebis(triethylammonium iodide) (dihexone) show tubocurarine‐like activity; dioctasulphonium triethiodide and dioctazonium triethiodide were predominantly tubocurarine‐like but had some transitional properties, whilst didecasulphonium triethiodide and didecazonium triethiodide resembled decamethonium. Dihexazonium triethiodide was about equipotent with tubocurarine on the cat. Marked species variations in potency were observed. Theoretical implications are discussed.

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