There was little evidence of a difference in effectiveness between SCS and PMR in patients with refractory angina.

SCS treatment is associated with symptom relief and improved quality of life in patients with refractory angina pectoris suffering from severe coronary artery disease.

Background: Patients with refractory angina have significant morbidity. This study aimed to compare two of the treatment options, Spinal Cord Stimulation (SCS) and Percutaneous Myocardial Laser Revascularisation (PMR) in terms of clinical outcomes and cost-effectiveness.

SummaryThe quality of donor organs will determine the quality of life for the recipient and the importance of optimal management of the multi-organ donor is that the organs may benejit up to jive, critically ill, patients. The basic principle is to maintain suficient preload to minimise the need for inotropic support and it is recommended that all multiple organ donors should have central venous and arterial pressure monitoring in addition to adequate venous access. The importance of the choice offluid for volume expansion and the management of the hormonal disturbances which follow brain death are considered. Key wordsTransplantation; heart, heart-lung. Management; donors.Management of the potential donor referred for organ retrieval presents an unfamiliar clinical situation for some intensive care and anaesthetic staff. Those responsible for the care of donors in the peri-operative period may have limited experience of the problems that may arise, both as a result of the pathophysiological changes that accompany brainstem death and of the organ retrieval procedure. Heart and heart-lung transplantation is a means of treatment for end-stage cardiopulmonary disease and it is important that organs are not lost from the limited supply as a result of inadvertent mismanagement before and during organ retrieval. Medical and nursing staff may tend to devote their skill and attention to other patients, once a patient is declared brainstem dead. The donor thus undergoes two periods of intense medical activity punctuated by a period of relative neglect: the first after admission to Intensive Care Unit before declaration of brainstem death in a bid to preserve life, the second during the organ retrieval operation to maintain sufficient stability to allow satisfactory harvesting. Between these two periods, however, little attention may be focused on maintaining the donor patient in an optimum state. It is during this time that damage to organs may occur. Potential causes of cardiopulmonary dysfunction in donorsIrreversible cerebral injury in the majority of donors is the result of trauma or catastrophic intracranial haemorrhage.',Z Functional deterioration may occur as a part of the natural history of massive cerebral injury and from iatrogenic causes, although donor heart and lungs are, by implication, free of serious intrinsic disease. Death of the brainstem, in the natural course of events, is followed by a steady decline in cardiovascular stability. Progressive vasodilatation occurs and the hypotension that this produces may be compounded by impairment of myocardial performance. Marked impairment of ventricular function has been demonstrated in animal models of brainstem death and in brainstem-dead patient^.^.^ Electrocardiographic and enzyme changes indicative of myocardial damage occur in association with subarachnoid haemorrhage and traumatic head injury in patients with no history of myocardial p a t h o l~g y .~.~ Moreover 30% of donor hearts biopsied before removal show evidence of cellular degeneration; this corr...

A case of accidental massive overdose of lignocaine while a patient was on cardiopulmonary bypass is described. The benefits of cardiopulmonary bypass and cardiac pacing in the management of the patient are discussed.