A study was conducted on 100 middle-aged to elderly patients (n=52, healthy; n=48, suffering from either diabetes, hypertension, ischaemic heart disease or combination of these diseases) undergoing cataract extraction to assess the effects of laryngoscopy and tracheal intubation, anaesthesia and surgery, eye bandaging and tracheal extubation, saline (control), magnesium sulphate 40 mg kg−1, esmolol 4.0 mg kg−1, lignocaine 1.5 mg kg−1 and glyceryl trinitrate 7.5 μg kg−1 given i.v. at induction of anaesthesia on heart rate (HR), blood pressure (BP), rate-pressure product (RPP) and pressure-rate quotient (PRQ). Anaesthesia was standardized. Haemodynamic responses and requirements for atropine, ephedrine and labetalol to maintain HR and BP during surgery were similar inhealthy and diseased patients, and in the test drug groups. Differences produced by the test drugs were evident until 5 min following intubation. Esmolol prevented rises in HR and RPP. Glyceryl trinitrate prevented a rise in BP, but was associated with tachycardia and a fall in PRQ to < 1.0. Magnesium sulphate and lignocaine did not prevent responses to laryngoscopy and tracheal intubation, and were associated with rises in RPP. Application of the eye dressing and tracheal extubation at the end of surgery each caused significant increases in HR, BP and RPP in all groups.

Desflurane is a new inhalation anaesthetic with a low blood/gas solubility which should allow a fast emergence from anaesthesia. In a prospective open randomized study, desflurane was compared with isoflurane paying special attention to recovery and the quality of the post-operative period. The occurrence of pain and post-operative nausea and vomiting (PONV) was recorded during the first 20 post-operative hours. Seventy women ASA Grade I-II scheduled for elective gynaecological laparoscopic procedures were studied. Patients receiving desflurane were extubated earlier than patients receiving isoflurane, 5±1 and 9±1 min respectively (P < 0.05) and the patients anaesthetized with desflurane were able to tell their name and date on average 5 min earlier than those who had received isoflurane; however, time in the recovery room was the same for both groups of patients. Twenty-two of 35 patients receiving desflurane, and 18 of 35 receiving isoflurane required analgesia. PONV was recorded in 18 patients anaesthetized with desflurane and 12 patients anaesthetized with isoflurane. In both groups PONV was more frequently observed in patients after leaving the recovery room. PONV in the recovery room was associated with a delayed discharge, 139 vs. 114 min respectively. Desflurane seems to be an useful alternative to isoflurane for laparoscopic procedures.

This present study investigated the effects of intraarticular morphine administration in 1mg and 5mg doses on post-operative pain relief and analgesic requirements for patients undergoing arthroscopic procedures. At the end of the operation patients were randomly allocated in a double-blinded fashion into three groups. The control group (Group 1) received normal saline 20 mL intraarticularly. The patients in the second and third groups received intraarticular morphine sulphate 1 and 5mg in saline 20 mL, respectively. Post-operative pain was assessed on the 1st, 6th and 24th hour by visual analogue scale (VSA). Supplementary analgesic requirement and possible complications were also followed. The intensity of pain and analgesic requirement were reduced more in the morphine 5mg group than in the control group. It is concluded, that the administration of intraarticular morphine 5mg provides long-lasting and effective analgesia after knee arthroscopy.

Combined effects of prolonged prostaglandin E1 (PGE1)-induced hypotension and haemodilution on hepatic function were studied in 30 patients undergoing hip surgery. The patients were randomly allocated to one of three groups; those in group A (n = 10) were subjected to controlled hypotension alone, those in group B (n = 10) to haemodilution alone and those in group C (n = 10) to both controlled hypotension and haemodilution. Haemodilution in groups B and C was produced by withdrawing approximately 1000 mL of blood and replacing it with the same amount of dextran solution, and final haematocrit values were 21 or 22%. Controlled hypotension in groups A and C was induced with PGE1 to maintain mean arterial blood pressure at 55mmHg for 180 min. Measurements included arterial ketone body ratio (AKBR, aceto-acetate/3-hydroxybutyrate) and clinical hepatic function parameters. AKBR and biological hepatic function tests showed no change throughout the time course in groups A and B. In group C, AKBR showed a significant decrease at 120 min (−40%) and at 180 min (−49%) after the start of hypotension and at 60 min (−32%) after recovery of normotension, and SGOT, SGPT, LDH and total bilirubin showed significant increases after operation. The results suggest that a prolonged combination of more than 120 min of PGE1-induced hypotension and moderate haemodilution would cause impairment of hepatic function.

We have assessed prospectively the time to readiness for surgery following axillary block (sum of block performance and latency times) in 80 patients. The brachial plexus was identified using a nerve stimulator, and anaesthetized with 45 mL of mepivacaine 1% with adrenaline 5 μgmL−1. In group 1 (single injection) the whole volume of mepivacaine was injected after locating only one of the plexus nerves. In group 2 (multiple injections) at least three plexus nerves were located, and the volume of mepivacaine was divided between them. Sensory block was assessed by a blinded observer every 10 min. Patchy analgesia was supplemented after electrolocating the unblocked nerves after 20, 30 or 40 min. The patient was pronounced ready for surgery when analgesia was present in all areas to be operated upon, which always included the three nerves to the hand. The single injection technique required less time for block performance (mean 5.5 min) than multiple injections (mean 9.5 min), P < 0.0001. However, latency of the block was longer and the requirement for supplemental nerve blocks was greater, after single injections (33 min and 57%) than after multiple injections (15.5 min and 7%, respectively), P < 0.0001. As a result, readiness for surgery was achieved faster in group 2 (25 min), than in group 1 (38.5 min), p < 0.0001. After supplementation, block effectiveness was 100% in group 1 and 98% in group 2 (NS). The frequency of adverse effects (vessel puncture or paraesthesia) was similar in both groups. No neurological sequelae were observed.We conclude that the multiple injection technique takes longer to perform than single injection, but that readiness for surgery is faster because of shorter block latency and better spread of analgesia.

Nausea and vomiting remain unpleasant side effects of intrathecal (i.t.) morphine and of the numerous therapies tried, only prophylactic intravenous (i.v.) metoclopramide has been reported to be promising. Seventy-three patients, scheduled for orthopaedic prosthesis surgery of the hip or knee were studied. They received 4mL of plain bupivacaine and 0.3 mg of preservative-free morphine i.t. for anaesthesia. The test drugs given in a double-blind and randomized fashion, were either metoclopramide 20 mg, three times, at 6 h intervals (23 patients), ondansetron, 8 mg, twice, at 12 h intervals (25 patients), or 0.9% saline three times, at 6 h intervals (25 patients). The occurrence of nausea, vomiting and pain was followed for 24 h. The incidences of nausea and vomiting were 60% (15/l25) and 56% (14/25) in the saline group, 52% (12/23) and 48% (11/23) in the metoclopramide group, and 52% (13/25) and 40% (10/25) in the ondansetron group. Incidences of severe vomiting were 24, 35 and 12%, respectively. Eight patients in the saline group, seven in the metoclopramide and 10 in the ondansetron group did not need additional opioids for post-operative pain relief. We conclude that, metoclopramide and ondansetron were not better than saline in the prevention of post-operative emesis induced by intrathecal morphine.

Reports about post-operative infections associated with the use of propofol prompted us to investigate the in-use contamination of lipid-formulated intravenous (i.v.) anaesthetics used for general anaesthesia or for sedation of intensive care patients in this department. The level and incidence of extrinsic contamination of propofol (‘Diprivan’) and of another intravenous anaesthetic, etomidate, formulated in lipid solution (‘Etomidat-lipuro’) was found to be low during two study periods. However, the need to observe strict aseptic precautions in handling these intravenous drugs must be emphasized.

A randomized double-blind study was carried out on 20 patients after coronary artery bypass surgery to investigate the effects of graded doses of dopexamine hydrochloride or placebo on systemic haemodynamic responses and renal vascular resistance index (RVRI) measured using Doppler ultrasound. Pre-operatively, all patients had good left ventricular function and normal renal function. Eleven were allocated randomly to receive incremental infusions of dopexamine 0.5, 1, 2, and 4 μg kg−1 for 40 min each, and nine received corresponding infusions of placebo. One patient was withdrawn from the dopexamine group because of tachycardia. In the remaining 19, heart rate (HR) and cardiac index (CI) were significantly (P < 0.05) increased from base-line with dopexamine: the HR values with dopexamine differed significantly from those with placebo at the 2 and 4 μg kg−1 min−1 dose, and at 4 μg kg−1 min−1 for CI. Systemic vascular resistance index (SVRI) fell significantly in both groups: the reduction was significantly greater with dopexamine 4 μg kg−1 min−1 than with the corresponding infusion of placebo. RVRI increased and urine output decreased significantly during the infusions in both groups, but with no significant difference between groups. There were no changes in systemic arterial pressures, pulmonary artery occlusion pressures, stroke volume index or left ventricular stroke work index. Where changes from base-line occurred in either group, they had not returned to base-line within 40 min of stopping the infusions (except perhaps for CI in the dopexamine group). Dopexamine appears to offer no particular protection to the renal vascular bed.

In this double-blind placebo controlled study the preoperative cardiovascular and metabolic effects of intramuscular (i.m.) clonidine and midazolam are assessed. Forty-five ASA Grade I patients (n = 15 per group) undergoing plastic surgical procedures were randomly allocated to receive either placebo, clonidine 4 μg kg−1 or midazolam 70 μg kg−1. Drugs were administered into the deltoid muscle [thkap ]90 min prior to the scheduled induction of anaesthesia. The metabolic measurements were performed using an indirect calorimetry device. Heart rate and blood pressure were measured noninvasively. Pre-operative subjective anxiety, dryness of mouth and tiredness were assessed using visual analogue scales (VAS). Clonidine increased subjective tiredness significantly more than placebo. Clonidine also induced moderate decreases in blood pressure and heart rate. Oxygen consumption (̇VO2), CO2) production and energy expenditure (EE) decreased significantly after clonidine and midazolam. The decrease in ̇VO2) and EE was maximally 11–14% on average from the base-lines after clonidine and midazolam. These effects were of longer duration after clonidine and lasted until the end of the 90 min study period. In conclusion, both clonidine and midazolam are effective as a means of decreasing pre-operative ̇VO2) and EE.

Irrigation of the bladder after transurethral resection of the prostate is often distressing because of pain arising from detrusor muscle spasm. The effect of post-operative oral diazepam was compared with sacral epidural (caudal) block at the time of surgery, both treatments together and a control group, assessed by three-point rank scoring. Either treatment significantly reduced the incidence of pain reported by patients, P < 0.001. No patient experienced pain after both treatments.

A case of endotracheal tube break into two parts during extubation is reported

The relation between intra-operative gas exchange and post-operative oxygen saturation was examined using pulse oximetry (SpO2) 30 h after anaesthesia for upper abdominal surgery. The inspired oxygen partial pressure (PIO2) was varied during anaesthesia to produce a plot of PIO2 vs. SpO2. Gas exchange during anaesthesia was inferred from the relation between PIO2 and SpO2 which was described by its lateral and vertical displacement away from the position of a standard oxygen dissociation curve. With patients breathing air, the SpO2 was measured over a 10-min period at 30 h after surgery. The correlation coefficient of the lateral displacement with post-operative SpO2 was 0.7, and that of the vertical displacement with post-operative SpO2 was 0.66. The correlation coefficient of intra-operative SpO2 at PIO2 = 21 kPa with post-operative SpO2 was 0.69. It can be concluded that gas exchange abnormalities during anaesthesia deduced from the displacement of the PIO2 vs. SpO2 curve correlate with SpO2 30 h post-operatively and may help to identify patients at risk of post-operative hypoxaemia.

The relation between intra-operative gas exchange and post-operative oxygen saturation was examined using pulse oximetry (SpO2) 30 h after anaesthesia for upper abdominal surgery. The inspired oxygen partial pressure (PIO2) was varied during anaesthesia to produce a plot of PIO2 vs. SpO2. Gas exchange during anaesthesia was inferred from the relation between PIO2 and SpO2 which was described by its lateral and vertical displacement away from the position of a standard oxygen dissociation curve. With patients breathing air, the SpO2 was measured over a 10-min period at 30 h after surgery. The correlation coefficient of the lateral displacement with post-operative SpO2 was 0.7, and that of the vertical displacement with post-operative SpO2 was 0.66. The correlation coefficient of intra-operative SpO2 at PIO2=21 kPa with post-operative SpO2 was 0.69. It can be concluded that gas exchange abnormalities during anaesthesia deduced from the displacement of the PIO2 vs. SpO2 curve correlate with SpO2 30 h post-operatively and may help to identify patients at risk of post-operative hypoxaemia.

We present the anaesthetic and surgical management, and post-operative course of a patient with osteogenesis imperfecta which exemplifies the problems associated with this condition. The observed petechial haemorrhagic rash is not characteristic of the bleeding tendency in osteogenesis imperfecta nor characteristic of acute disseminated intravascular coagulation. Despite potential life-threatening complications the patient made a good recovery and was discharged 3 weeks after surgery.

The present study describes the management of a myasthenic patient undergoing transsternal thymectomy for whom thoracic epidural anaesthesia using 15 mL of bupivacaine 0.5% combined with isoflurane 0.4% and nitrous oxide in oxygen 50% provided good intra-operative relaxation followed by an uneventful recovery and eliminated the need for other post-operative analgesics.