Information about physician anaesthesiologist manpower in the countries of the European Union was collected from questionnaires sent to the delegates representing their respective countries on the European Board of Anaesthesiology.

In the countries of the European Union and Switzerland and Norway 40 259 specialist anaesthesiologists are recorded. The number of anaesthesiologists in relation to population varies between as little as 4.4 and 4.6 (Ireland and UK) and as many as 15.6 (Italy), with a mean of 10.8/100 000 inhabitants. There are 11 610 physicians recorded in training in anaesthesiology.

The ratio of trainees to specialists in the European Union countries was 28.8/100, varying from as low as 6.5 in France, to as high as 96.7 and 98/100 in Ireland and the UK respectively.

These figures indicate a wide difference in the numbers of specialists and trainees between the European countries studied. However, the overall mean figure is close to that reported in the USA (9.2/100 000).

Atracurium causes a decrease in systemic vascular resistance (SVR) and mean arterial blood pressure (MAP) which has been ascribed to histamine release. However, histamine receptor blockade does not prevent these decreases completely. The hypotensive side effects of atracurium may not only be caused by histamine. In this study we examined the vasoactive effects of atracurium with and without histamine receptor blockade in an isolated femoral artery preparation of the rabbit. We also investigated whether vasodilatation caused by atracurium depends on the presence of endothelial cells. Tyrode perfused, rabbit femoral arteries were constricted with noradrenaline (NA) to ±70% of their passive diameter. Endothelial function was checked with acetylcholine (ACh). The vessels were divided into two groups. In both groups the responses to histamine (1.0−10−6m) and atracurium (3.2−10−5m) were determined. In group one (n = 5), the histamine and atracurium responses were repeated during histamine receptor blockade. In group two (n = 5), the diameter responses to histamine and atracurium before and after endothelium removal were compared. Also, some vessel segments (n = 5) were histologically prepared and examined for mast cells. The vasodilatory responses to atracurium both with and without histamine receptor blockade were the same. Removal of endothelium caused an increase in the histamine response, while the dilating response to atracurium remained constant. We conclude that in the isolated femoral artery of the rabbit, atracurium induces vasodilatation that is not mediated by histamine release and cannot be prevented with histamine receptor blockade. The mechanism of atracurium induced dilation is independent of the endothelium and is located in the smooth muscle cell.

Continuous monitoring of body temperature during anaesthesia is a widely accepted clinical practice for which a variety of techniques are used. In this study, the accuracy of the deep body thermometer (Coretemp®) was compared with temperatures measured by needle thermocouples. With IRB approval and informed consent, seven ASA physical status I and II patients undergoing otolaryngeal surgery were studied. General anaesthesia and neuromuscular blockade were induced with thiamylal and vecuronium. Anaesthesia was maintained with isoflurane at an end-tidal concentration of 1.0–2.0% and 66% nitrous oxide in oxygen. After induction of general anaesthesia, subcutaneous temperature was measured at the sole of the left foot using a Coretemp®. Additionally, 8-, 18-, and 38-mm-long needle thermocouples were inserted into the the sole of the left foot close to Coretemp® and skin-surface temperature was also recorded adjacent to the needles. The Coretemp® measurement (Tc) correlated best with 18-mm-deep needle temperature (r2 = 0.87). There was also a good correlation between Tc and 38-mm-deep needle temperature (r2 = 0.83). Skin and 8-mm-deep needle temperatures correlated poorly or only moderately with Tc (r2 = 0.67, 0.75, respectively). These results indicate that temperatures measured by Coretemp® well reflect the temperatures at a depth of 18 mm or more from the skin into the foot.

Etomidate-induced suppression of cortisol biosynthesis is a result of a blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazol radical of etomidate. Since the generation of steroids requires reductive and energy rich equivalents, the present study examined whether supplementation with ascorbic acid or xylitol, a major source of NADPH, could attenuate adrenal suppression by etomidate in human subjects by promoting the turnover rate of 11-beta-hydroxylase. During continuous etomidate/alfentanil anaesthesia for pelviscopic surgery 30 female patients received either Ringer's lactate, xylitol (0.25 g kg−1 h−1) or ascorbic acid (0.5 g h−1) intravenously (i.v.). The plasma concentrations of cortisol, aldosterone and dehydroepiandrosterone (DHEA) were recorded for 5 h after end of surgery and a stimulation with synthetic ACTH was performed. The results showed no evidence of a clinically relevant attenuating effect of ascorbic acid or xylitol on etomidate-induced adrenocortical suppression. However, the observed suppression of cortisol levels was not enough to allow an attenuating affect to be measured.

The present study was designed to determine the direct effects of halothane, isoflurane and sevoflurane on the bovine epicardial coronary artery as well as their mode of action. We chose serotonin as the vasoconstrictor because it also causes endothelium-dependent relaxation of coronary arteries. Isolated spiral strips of bovine epicardial coronary artery with and without endothelium were suspended for isotonic contraction recordings in Tyrode's solution. KCl (80.4 mm) solution induced maximal contraction, regarded as the reference value (100%). The muscle strips were then exposed to increasing concentrations of serotonin from 10−8 to 10−4 m in the presence and absence of 1.5 MAC halothane, isoflurane or sevoflurane. All three drugs attenuated serotonin-evoked contraction in the coronary artery strips both those strips with and without endothelium (P < 0.05−0.001). However, there were no significant differences in the attenuation of serotonin-induced contraction of the strips, both with and without endothelium, in each drug group. The attenuation potency of halothane was more than that of isoflurane and sevoflurane. The results demonstrate that halothane, isoflurane and sevoflurane attenuate contractile responses evoked by serotonin in bovine epicardial coronary artery both with and without endothelium.

In a randomized double-blind study 60 children, undergoing the extraction of carious deciduous teeth under day-case general anaesthesia, were assigned to receive either intravenous nalbuphine hydrochloride 0.3 mg kg−1 (n = 21), one or more diclofenac suppositories 12.5 mg to a dose of 1–2 mg kg−1 (n = 19), or no analgesia (n = 20). The duration of anaesthesia was longer in the diclofenac group (9.6 min, SD 3.5) compared with control (7.2 min, SD 2.6) and nalbuphine (6.9 min, SD 3.0) groups respectively (P < 0.05). There were no statistically significant differences in post-operative pain scores during the 45 min post-operative period studied between the three groups using an objective pain score. We conclude that using this methodology we were unable to demonstrate any statistically significant differences between the analgesic effects of either intravenous (i.v.) nalbuphine or diclofenac suppositories compared with control.

Prolongation of the QT interval may produce potentially hazardous arrhythmias. The effects of midazolam or propofol, followed by suxamethonium on the QT interval have been investigated. Thirty patients, ASA I or II, without cardiovascular disease, electrolyte abnormalities or receiving any medication were studied. All patients were premedicated with midazolam 0.08 mg kg−1 i.m., 30–60 min prior to surgery. Anaesthesia was induced with either midazolam 0.4 mg kg−1 i.v., (15 patients) or propofol 1 mg kg−1 i.v. bolus, followed by a continuous infusion (15 patients). ECG, heart rate and arterial pressure were measured before induction of anaesthesia and at 1 and 3 min after the bolus of midazolam or propofol. Further recordings were obtained at 1 and 3 min after a bolus of suxamethonium 1.5 mg kg−1 i.v. and also immediately after tracheal intubation and 1 min later. Neither midazolam nor propofol had any significant effect on QTc interval. Prolongation of QTc was observed in both groups after suxamethonium and this was further prolonged following intubation. Heart rate and arterial pressure were also increased significantly in both groups following intubation.

One hundred and one women (ASA grades I and II) were anaesthetized for routine gynaecological surgery using an intravenous (i.v.) anaesthetic technique combining propofol and alfentanil. The patients were allocated randomly into groups. Group one received 33% oxygen in nitrous oxide and group two received 33% oxygen in air (total i.v. anaesthesia). The group receiving nitrous oxide required significantly less (P < 0.05) of the propofol and alfentanil mixture to maintain anaesthesia and this was found to reduce the mean cost of anaesthesia by £1.70, (P < 0.05). There was no significant difference in the incidence of post-operative complications between the two groups. We suggest that nitrous oxide may be used to reduce the cost of total i.v. anesthesia with propofol and alfentanil without causing any increase in post-operative morbidity in patients undergoing routine gynaecological surgery.

The effectiveness of a Eutectic Mixture of Local Anaesthetics (EMLA cream) for pain control during renal extracorporeal shock wave lithotripsy (ESWL) was evaluated in a group of 20 patients who had not been able to tolerate a previous session without intravenous (i.v.) analgesia. EMLA cream (10 g) was applied on the skin over the area (64–100 cm2) where the shock waves were to be focussed. A second generation lithotriptor Siemens Lithostar was used. The following measurements were made: the shock wave (kV) maximum voltage, the number of successful stone fragmentations (SSF), the visual analogue scale score (0–10) for pain (VAS), and the tolerance scale score (1–4) for the tolerance for the procedure. Significantly higher voltage (17.9±0.6 kV vs. 16.2±0.8 kV), lower VAS scores (5.9±1.1 vs. 8.7±1.3), lower TS score (2.3±0.6 vs. 3.6±0.6) and a higher number of SSF (18 vs. 5) were found in those patients for whom EMLA cream was used. Intravenous analgesia was not needed in nine patients. Nine patients received fentanyl 0.05 mg, one 0.10 mg and another 0.15 mg. These favourable results were attributed both to the sequence of gradual voltage increments used and to the cutaneous analgesia produced by EMLA cream.

The effect of the duration of stabilization of control responses on the onset and duration of clinical relaxation of suxamethonium 1 mg kg−1 and rocuronium 0.6 mg kg−1 were investigated in 90 patients. The control responses were allowed to stabilize for 1, 5, 10, 15 or 20 min prior to administration of rocuronium and for 1, 5, 10 or 15 min prior to suxamethonium. The mean onset time for rocuronium decreased from 150 to 46 s as the duration of stabilization increased from 1 to 20 min (P < 0.001) although the maximal effect was observed within the first 5 min. The average duration of clinical relaxation also increased from 25 to 40 min (P < 0.001). No effect was observed for either variable in the case of suxamethonium.

A case of myocardial infarction following a distal splenorenal shunt, a selective portal-systemic shunt, in a cirrhotic patient is reported. The post-operative cardiac morbidity was probably related to the hyperdynamic cardiovascular state associated with liver cirrhosis and the increase in intramyocardial tension upon formation of the distal splenorenal shunt.

A general relation between the rate of onset and rate of recovery from non-depolarizing blockade has been demonstrated, with recovery consistently about ten times slower than onset. This observation has led to the suggestion that non-depolarizing agents share a common mechanism of action. Rocuronium, a recently introduced steroidal non-depolarizing agent, is claimed to have a very rapid onset but an intermediate duration and appears to test this hypothesis. To investigate this paradox we have calculated the rates of onset and recovery of rocuronium using the isolated human forearm and compared them with those of pipecuronium. The mean ratio of recovery time/onset time for rocuronium was 31.3, which is significantly greater than that for pipecuronium, 11.6 (P < 0.01). Whilst pipecuronium conforms to the same general relation between onset and offset described previously for other non-depolarizing agents, rocuronium appears to have a disproportionately rapid rate of onset for its rate of recovery. This suggests that onset, recovery, or both onset and recovery, from rocuronium blockade occur in a different manner to that of other non-depolarizing agents.

A survey was conducted among British, French and German anaesthetists to evaluate possible national differences in the peri-operative use of muscle relaxants and their reversal agents. The same non-depolarizing relaxants are used in all three countries, with the exception of d-tubocurarine, which is only available in Great Britain, and alcuronium which is mainly used in Germany. The French anaesthetists seem to use significantly less succinylcholine than their peers in Great Britain or Germany for both elective and emergency intubation. Monitoring of neuromuscular blockade still relies mainly on ‘clinical judgement’. Reversal of non-depolarizing muscle relaxants is performed routinely in Great Britain, while a substantial number of French anaesthetists avoid the use of a reversal. Dose regimes for neostigmine vary largely, with German anaesthetists administering the lowest, and British anaesthetists administering the highest doses. Side effects of reversal agents are reported by colleagues from all three countries in too high a percentage to justify uncritical administration of these drugs. In Germany there seems to be a noteworthy lack of recovery facilities.

A prospective study of a method of anaesthetizing children for magnetic resonance imaging was carried out. The end-tidal carbon dioxide, respiratory rate and oxygen saturation of 23 children undergoing magnetic resonance imaging were monitored. The children underwent halothane anaesthesia breathing spontaneously via an endotracheal tube and a modified Bain breathing system.

The children were divided into two age groups. In all groups the end-tidal carbon dioxide and oxygen saturation values remained at or near normal for the duration of the scan. All children were recovered within 10 min and there were no post-anaesthetic problems. We suggest, that in the absence of respiratory problems or a rise in intracranial pressure, this is a safe and appropriate technique for magnetic resonance scanning in the child.

Sixty patients presenting for in-patient gynaecological laparoscopic surgery were randomly allocated to receive either diclofenac 75 mg (n = 20), ketorolac 30 mg (n = 20) or piroxicam 20 mg (n = 20) as an intramuscular (i.m.) injection immediately after induction of anaesthesia. Post-operative Visual Analogue Scores at rest, over the first 24 h after surgery, using a 10 cm scale, ranged from 3.2–0.5 in the diclofenac group, 2.7–0.85 in the ketorolac group and 2.8–0.5 in the piroxicam group. The scores did not differ significantly between the three groups (P > 0.05). Mean time (SD) to first analgesia was 27 (94) min in the piroxicam group, 16 (30) min in the diclofenac group and 62 (120) min in the piroxicam group. Six out of 20 patients in the diclofenac group required further analgesia compared with nine out of 20 in the other two drug groups, this was not significant. There were no reports of increased bleeding, bronchoconstriction, bleeding from the upper gastrointestinal tract, renal impairment or pain from the intramuscular (i.m.) injection site in any of the groups. The administration of a non-steroidal anti-inflammatory drug to patients presenting for laparoscopic surgery reduces post-operative pain and analgesic requirements, and piroxicam 20 mg provides a suitable alternative to 75 mg diclofenac and 20 mg ketorolac.

Abnormalities of platelet haemostasis pose increased risk to patients undergoing anaesthesia and surgery. We have investigated the effect of propofol on platelet aggregation in 12 patients undergoing upper and lower abdominal surgery. Propofol 2.5 mg kg−1 was administered via a cannula in the antecubital vein. Venous blood samples were obtained before induction and 10 min after administration of propofol. Platelet aggregation measurements were made for adenosine diphosphate (ADP), collagen and adrenaline. The results show that propofol does not affect platelet aggregation in the concentrations used.

In a randomized, double-blind investigation the analgesic effect of continuous blockade of the lumbar plexus as an adjunct to acetylsalicyclic acid by suppository after surgery for femoral neck fractures under spinal anaesthesia was examined in 20 patients. Before surgery, a catheter was inserted into the femoral nerve sheath. The patients were allocated randomly to receive bupivacaine or saline by bolus and then continuous infusion, started immediately after the operation. No statistically significant differences in additional morphine requirements, visual analogue pain scores or adverse effects were observed between the two treatment groups. It is concluded that continuous blockade of the lumbar plexus as an adjunct to rectal acetylsalicyclic acid offers no major additional pain relief after surgery for femoral neck fractures under spinal anaesthesia.

General anaesthesia for a patient with tuberous sclerosis was complicated by epilepsy. The choice of drugs was related to control of his fits and intercurrent therapy. Thiopentone, vecuronium, and nitrous oxide with isoflurane were satisfactory.