Patients who had cataract surgery under topical anesthesia were highly satisfied with their operative experience and reported minimal pain during surgery. Anxiety levels diminished after arrival at the hospital, possibly because of reassurance by experienced staff. Intravenous midazolam did not seem to significantly reduce pain or anxiety.

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We audited a total of 1233 patients scheduled for elective cataract extraction or trabeculectomy using peri-bulbar anaesthesia. A bolus of propofol provided sedation to cover insertion of the block. During an initial two-year period we collected data on the amount of propofol used to sedate 481 patients. Multiple linear regression analysis was then used to obtain an equation to link the dose used to age and weight in those who were adequately sedated. The dose of propofol in milligrams was calculated as 56 + 0.25 x weight (kg) - 0.53 x age (yrs). We subsequently assessed the effectiveness of this formula at abolishing recall of the injections whilst not compromising the airway on a further 752 patients. This simple regime was effective at abolishing recall of the block in 78.6% of the patients studied and avoids the cost and logistic implications of more complicated drug delivery systems. Use of the formula does not significantly alter the incidence of recall compared to sedation provided by an experienced ophthalmic anaesthetist. We hope it will provide a guide for more junior anaesthetists to obtain the satisfactory sedation level that comes with experience.

Summary A regimen to facilitate control of epidural inyusions in Key wordsAnalgesia; obstetric. Anaesthetic techniques, regional; epidural.In the UK, epidural analgesia in labour is usually provided by anaesthetists who give the first dose of local anaesthetic via a catheter in the epidural space. Subsequent doses or top-ups arc frequently given by midwives. Occasionally, problems may arise during epidural analgesia and considerations of patient safety are paramount.The continuous epidural infusion of bupivacaine is an cstablished method of providing analgesia and has been notcd to reduce medical staff workload when compared with a conventional top-up techniqucS An element of increased safety may also result because the number of bolus injections into the epidural space is reduced. Our hospital delivers around 5500 patients each year and the epidural rate for labour is 19%; topups are performed by trained midwives. We elected to try epidural infusions in this setting and devised an infusion technique to meet certain specific requirements for patient safety, efficacy and midwife control of the infusion.Bupivacaine concentrations from 0.125 to 0.3% are regarded as optimum for infusion by various workers,l . 3 . 4 . 6 We chose 0.25% since, in a pilot study, this concentration provided good analgesia but acceptably little motor block. MethodsA flow chart based on hourly clinical observations was developed in order to facilitate midwife control of the infusion (Fig. 1). The rate of infusion was altered according to a prescription chart (Table 1) and, once in place, was regulated by midwives unless a problem developed, when an anaesthetist was called.A pilot study was conducted in 15 patients to check the efficacy of the technique. We then compared 30 primigravidae who received conventional epidurals with 30 who rcceived our infusion technique. Only primigravidae whose labour was expected to last a further 4 hours were included. Thirty consecutive patients who met these criteria were given infusions and the following 30 patients were given top-up epidurals.All patients received 500-1000 ml preload of Hartmann's solution intravenously. The epidural space was identified by loss of resistance to air, using the midline approach and a 16-gauge Tuohy ncedle. In all cases a Portex epidural catheter was inserted; 2 4 cm were left in the epidural space and an epidural filter (Millex 0 . 2 2~) was connected in series. Each mother then received 8-10 ml (including the 3-ml test dose) of 0.5% plain bupivacaine.

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