WD is a diverse chronic disease with generally favourable outcomes for patients who respond to initial therapy, which can be managed predominantly in an ambulatory setting.

Pre-operative obstructive sleep apnoea correlated significantly with post-operative respiratory distress, supplementary oxygen requirement, nasopharyngeal airway insertion and hospital stay. We recommend pre-operative sleep investigations for all children undergoing cleft palate repair, to enable appropriate timing of the procedure.

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SummaryFactors affecting the spread of bupivacaine in the paravertebral space were investigated in patients undergoing paravertebral nerve blocks for the treatment of chronically painful conditions. Injections of bupivacaine 0.5%, 10-15 ml mixed with depomedrone up to 80 mg were repeated at 2-wk intervals up to a maximum of four times. A blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5-min intervals after each injection. Age, sex, height and weight did not correlate with the block; nor did injectate volume, mass of bupivacaine, previous posterolateral thoractomy and spread of radiocontrast. Injections repeated at 2-wk intervals in the same patient resulted in different degrees of spread that were unrelated to one another. Time to peak onset of blockade was 40 min in 95% of patients. A single bolus of bupivacaine produces a safe but unpredictable block. Yet to be defined physical properties and anatomical factors are probably key determinants of the spread of bupivacaine in the paravertebral space. This single bolus technique may be better supplanted by a reversion to the older multiple level injection technique.Keywords Local anaesthetic. Bupivacaine: nerve block, intercostal nerve. Two aspects of paravertebral nerve blocks that have been poorly investigated are the predictability of spread of local anaesthetic and the reliability of production of the block. To identify any involved factors, we undertook this prospective, single-blinded, longitudinal, observational study of patients undergoing therapeutic paravertebral blocks as a part of their chronic pain management. MethodsThe study was approved by the local ethics committee and written informed consent was obtained from all patients.Patients listed for therapeutic paravertebral injections as a component of management of chronically painful conditions of the chest and abdomen were included in the study. Those with a pre-existing sensory deficit were excluded. A single injection technique was used, as described elsewhere [1]. All blocks were performed to the satisfaction of the same experienced operator (J.R.). Correct Tuohy needle placement alongside the vertebral column superior to the transverse process in each patient was confirmed through the injection of 3 ml of radioopaque dye (Isovist, Schering, Germany). All material was injected with the Tuohy needle opening pointing cranially and contrast medium was tracked with an image intensifier, its shape being categorised as globular or as a cranio-caudal streak. Bupivacaine 0.5%, 10-15 ml mixed with depomedrone up to 80 mg was injected over 60 s.In the recovery room, a blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5-min intervals until a stable block had been established, i.e. two 5-min observations were the 684Ó 2003 Blackwell Publishing Ltd same. The cold stimulus used was a mixture of ice in tap water contained in a copper test tube. Each patient also had non-invasive measurements...

SummaryThe prevalence of latex allergy has increased since the 1980s. As latex is found throughout hospitals and operating theatres, careful planning is required for latex-allergic patients who present pre-operatively. We conducted a postal survey of 269 departments of anaesthesia in England and Wales; responses were received from 208 (77%). Of these, 198 (95%) had a latex allergy protocol and 181 (87%) had a store of latex-free equipment. Only 113 (54%) had a named nurse and 58 (28%) had a named consultant responsible for the update of latex allergy provisions. Access to allergy clinics and further investigations were available to 189 (91%). Many respondents called for national guidelines. We are reassured that the majority of trusts have an up-to-date latex allergy protocol and latex-free equipment store. However, relatively few have nominated members of staff responsible for these and peri-operative care of susceptible patients.

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