P Pu ur rp po os se e: : To examine the effects of iv compound sodium lactate (CSL) with and without caloric supplementation with dextrose on nausea, vomiting and pain following general anesthesia for laparoscopy.

Purpose: Postanaesthetic shivering occurs in 5-65% of patients. In addition to causing discomfort, it is associated with deleterious consequences. Our objective was to investigate the effect of 150/ag clonidine, at induction of anaesthesia, on perioperative core and peripheral temperature, incidence of postanaesthetic shivering and patients' perception of cold. Methods: Sixty ASA I or 2 patients scheduled for elective orthopaedic limb surgery were randomly allocated to group I, who received 150/Jg clonidine iv, or group 2, who received a saline bolus iv, before induction. In alI patients, anaesthesia was induced with fentanyl and propofol and maintained by spontaneous respiration (via a laryngeal mask airway) of oxygen, nitrous oxide and enflurane. Core (nasopharyngeal) and peripheral (dorsal hand) temperatures were recorded at induction and 15-rain intervals. Nurses, unaware of the treatment groups, recorded visible shivering in the recovery room, When cognitive function returned, patients were asked to grade their perception of cold on a I 0 cm linear analogue scale, higher scores indicating heat discomfort.Results: While core temperature decreased and peripheral temperature increased in both groups, there was no difference between the groups at any time. However, there was a lower incidence of shivering in the clonidine group (20% vs 66.7% P <0.00l ). Patients receiving clonidine felt warmer; thermal comfort score (median interquartile range) 5.9 (5.0-7.2) vs 5.0 (4.5-6.0), P <0.05).Conclusion: Clonidine 150 g iv at induction of anaesthesia reduces the incidence of shivering and patients' subjective perception of cold on emergence from general anaesthesia. R~sultats : Alors que la temp&ature centrale diminuait et la temp&ature pEriphErique augmentait dans les deux groupes, aucune difference if&at notEe entre les groupes. Cependant, I'incidence du flisson Etalt plus basse dans le groupe clonidine (20% vs 66,7%, P <0,00 I). La perception de chaleur Etait plus ElevEe chez les patients sous clonidine avec un score de comfort (mEdiane &art interquartile de) 5,9 (5,0-7,2) vs 5,0 (4,5-6,0), P <0,05). Conclusion : AdministrEe ~. (induction, la donidine iv r~duit rincidence du fdsson et [a sensation subjective de froid per~ue au r~veil apr~s une anesth&ie gEn&ale.

Inadequate airway management may be fatal. There are recommendations for airway difficulties, but the evidence favoring any specific strategy is limited. This study suggests that, in the lateral position, a laryngeal mask airway more rapidly and reliably establishes airway control than attempts at endotracheal intubation. It further suggests that placing a patient with an inadequate airway into the lateral position will hinder, not help, airway management.

We have compared two methods of reducing hypotension during spinal anaesthesia in elderly patients, 6% hetastarch and crystalloid or methoxamine 10 mg i.m., in terms of haemodynamic stability and requirements for additional vasopressors. Sixty-two patients (aged 60-97 yr) undergoing surgical fixation of fractured neck of femur were allocated randomly to receive 6% hetastarch (Hespan) 500 ml followed by Hartmann's solution 500 ml (group HS, n = 32) or a bolus injection of methoxamine 10 mg i.m. (group MX, n = 30), 10 min before induction of spinal anaesthesia with 0.5% hyperbaric bupivacaine 2.25-3.0 ml. Arterial pressure was measured non-invasively by an oscillotonometer at 2-min intervals from 0 to 40 min and at 5-min intervals thereafter. Methoxamine 2 mg i.v. was given if systolic arterial pressure (SAP) decreased to < 100 mm Hg. Hypotension was defined as a 25% decrease from baseline SAP or mean arterial pressure (MAP). Patient data, sensory level and blood loss were similar in the two groups. SAP and MAP increased initially from baseline until induction of spinal anaesthesia and then decreased for 30 min in both groups, but remained higher in group MX (P < 0.05). Heart rate (HR) decreased from baseline in group MX (P < 0.05) and was less than in group HS at all times from 2 to 60 min (P < 0.01). The incidence of SAP hypotension (47% vs 75%; P = 0.03, odds ratio (OR) = 3.43) and MAP hypotension (47% vs 67%; P = 0.09, OR = 2.51) was less in group MX than in group HS. Requirements for rescue methoxamine i.v. (27% vs 53%, P = 0.04, OR = 3.11) was less in group MX than in group HS but the dose of rescue methoxamine given (mean 6.3 (95% confidence intervals 3.0-9.6) vs 8.9 (5.6-12.2) mg) and time to onset of hypotension (20.7 (14.5-26.7) vs 17.3 (11.4-23.1) min) were similar in groups MX and HS, respectively. We conclude that methoxamine 10 mg i.m., given 10 min before induction of spinal anaesthesia in normovolaemic elderly patients, reduced subsequent SAP and MAP hypotension, HR and requirements for rescue vasopressor therapy compared with a combination of 6% hetastarch 500 ml and crystalloid 500 ml. The previously reported benefit of such volume administration may not extend to the elderly.

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