for this group of local anaesthetics. This study demonstrates that 1 mL of 1% sodium bicarbonate solution A number of methods exist by which the pH of local may be used to alkalinize this range of local anaesthetic solutions may be increased. Most comanaesthetics without the risk of precipitation. We also monly, these require the addition of differing amounts conclude that Ropivacaine (at concentration 0.75% of sodium bicarbonate solution according to the local and 1.0%), is unsuitable for alkalinization since it preanaesthetic drugs. Sodium bicarbonate (1%) was ticipitates at a pH of 6.0. trated against pH in six commonly used local anaesthetic solutions. Titration curves of pH and vol-Keywords: local anaesthetics, alkalinization, sodium bicarbonate. ume of sodium bicarbonate solution added are shown commercial local anaesthetic solutions is in the

SummaryIn order to evaluate the contribution of tuba1 spasm to pelvic pain following laparoscopic sterilisation, we have studied the effecr ofglycopyrrolate, an anticholinergic agent with antispasmodic properties, on 60 ASA 1 and 2 patients presenting as day-cases ,for laparoscopic sterilisation using Filshie clips. In a randomised, double-blind, controlled trial, patients received either glycopyrrolate 0.3 mg or saline intravenously prior to induction of anaesthesia. Compared with the control group, patients receiving g1.vcopyrrolate had significantly reduced immediate postoperative pain scores (j < 0.02) and required significantly less postoperutive morphine @ < 0.01). Nausea, vomiting and anti-emetic requirements were also reduced though not significantly.We conclude that glycopyrrolate 0.3 mg at induction of anaesthesia is an effective method of improving the quality of recovery after day-case laparoscopic sterilisation using clips.

We report the successful use of combined spinal and extradural anaesthesia for elective Caesarean section in a primigravid patient with Ehlers-Danlos type IV (EDS IV). EDS IV is a rare disorder with a high pregnancy-related mortality. Previous reports have not addressed the question of anaesthesia for delivery. It is not possible to be didactic about anaesthetic technique for such patients. The relative risks of general and regional anaesthesia must be discussed fully, and the risks weighed against the wishes of the woman and her partner.

Mark Levine MB FRCPCPurpose: To compare the maintenance and recovery characteristics after sevoflurane with those after propofol in children with epidural blockade. Methods: F~cy unpremedicated, children ASA I-II, 2 -8 yr of age, scheduled for elective urological surgery as outpatients, were randomly allocated to receive either: I) sevoflurane for induction and maintenance of anaesthesia or 2) propofol for induction (2-3 mgkg -~ iv) and for maintenance (5-I0 mg-kg -t-hr -l iv). All children received N20 70% in oxygen before induction and throughout the anaesthetic, rocuronium for neuromuscular blockade and a lumbar or caudal epidural block before incision. Heart rate (HR), systolic blood pressure (SBP), recovery times and all side effects during maintenance and recovery were recorded by a blinded observer. Adverse events during the first 24 hr were also recorded. Results: Mean HR increased 5-10% after induction in both groups reaching a maximum by five minutes. Heart rate returned to baseline by skin incision in the sevoflurane group and by I0 min after induction in the propofol group. During maintenance, HR decreased by 10-20% below baseline values by 20 min in the propofol group only, where it remained for the remainder of the anaesthetic. Similarly, SBP increased by 10% after induction of anaesthesia in both groups, but returned to baseline by I 0 min. Light anaesthesia occurred in four (16%) children, all in the propofol group. Emergence and recovery indices were similar in the two groups. Discussion: Sevoflurane and propofol exhibit similar maintenance and recovery profiles when combined with epidural analgesia in children undergoing ambulatory surgery. Objectif : Comparer les caract~ristiques du maintien et de la r&up~ration de l'anesth&ie apt& l'administration de s~voflurane avec celles de l'anesth&ie apr~s le propofol chez des enfants qui ont subi un blocage p~ridural. M~thode : Cinquante enfants ASA I-II, ~g~s de 2 ~ 8 ans, qui n'ont re~u aucune premeditation, devaient subir une chirurgie urologique ~lective ambulatoire et ont ~t~ r~partis au hasard pour recevoir soit : I) du s~voflurane pour rinduction et le maintien de l'anesth&ie, ou 2) du propofol pour rinduction (2-3 mg'kg "~ iv) et de I'anesth&~e, du rocuronrum pour le blocage neuromuscula~re et une anestheste p~ndurale Iomba~re ou caudale avant rincision. La fr~quence cardiaque (FC), la tension art&ielle systolique (TAS), le moment de la r&up&ation et tousles effets secondaires pendant le maintien et la r&up~ration de I'anesth&ie ont ~t~ enregistr& par un observateur impartial. On a aussi not~ les &~nements ind~sirables pendant les 24 prerni~res h. R6,sultats : La FC moyenne a augment~ de 5-I 0 % apr& I'induction de I'anesth&ie dans les deux groupes eta atteint sa valeur maximale en cinq minutes. Elle est revenue ~ sa valeur de base Iors de rincision cutan& darts le groupe s~voflurane et en dix minutes apr& rinduction darts le groupe propofol. Pendant le maintien de ranesth&ie, la FC a diminu~ de 10-20 % sous sa valeur de base en 20 min dans le...