We conclude that in patients who have undergone mitral valve repair, postoperative infusion of hypertonic saline solutions increases left ventricular preload and left ventricular ejection fraction. The use of these hypertonic solutions may be of interest in patients with valvular cardiomyopathy. A titrated dose and a low rate of infusion may substantially improve the safety.

SummaryPethidine is reported to be more effective than equi-analgesic doses of other opioids as an inhibitor of postanaesthetic shivering. The aim of this study was to verifv whether this action resulted from a local anaesthetic effect of pethidine or from inadequate fentanyl dosage in previous studies. We studied 52 ASA I or Zpatients. They were randomly allocated, in a double -blind fashion, to one of four groups to receive either pethidine (0.85mg.kg-') or fentanyl (I. 7pg.kg-') kg-I). Key wordsComplications; shivering. Analgesics; fentanyl, pethidine. Anaesthetics, local; lignocaine.Shivering is a normal thermoregulatory response to perioperative hypothermia, which can be modified by opioids [I+. The degree of inhibition seems to depend on the specific drug administered and whereas pethidine is a well recognised treatment [5, 61, other p agonists, including fentanyl [5] and morphine [5, 61, have proved less successful. Explanations for the reported discrepancy between pethidine and fentanyl may be that these drugs were not compared at an equivalent dosage or that pethidine acts peripherally [5, 71. Apart from its opioid effects [8], pethidine possesses other pharmacological properties [9-121, including a membrane stabilising effect [9]. It is well established that lignocaine I mg.kg-', when administered intravenously, has an analgesic effect [I 31 probably mediated through A6 and C fibres [14], both of which transmit thermal inputs from cutaneous receptors [I 51. The peripheral effect of pethidine could be associated with this property.The aims of this double-blind, controlled study were ( I ) to verify if, at higher dosage, pethidine and fentanyl had comparative effects on postanaesthetic shivering and (2) to investigate the possibility, using lignocaine, that the superiority of pethidine could be attributed to its stabilising membrane effect. MethodWith the approval of the local ethics committee, 465 postoperative ASA 1 or 2 adults were studied. They had all received a general anaesthetic lasting at least I h for noninfective orthopaedic or abdominal surgery. Anaesthesia was induced with thiopentone (5 mg.kg-' ) and fentanyl (2 pg.kg-'). Tracheal intubation was facilitated with vecuronium (0. I mg.kg-l). Anaesthesia was maintained with isoflurane and fentanyl as required.On arrival in the recovery room, the criteria for inclusion in the study were as follows: spontaneous ventilation, a core temperature below 36°C and vigorous shivering. Fifty-two patients met these criteria and were studied using a doubleblind design. Patients were randomly allocated to receive either pethidine (0.85 mg. kg-I) (n = 13), fentanyl (1.7pg.kg-I) (n = 13), lignocaine I mg.kg-' (n = 13) or

Summa ySimplified guidelines for intra-operative fluid therapy were evaluated in two groups of children (aged 3 months-10 years) undergoing minor non-haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmol-1-l, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post-operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in chiIdren receiving 5% dextrose in 0.3 N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 N saline, particularly in children younger than 4 years of age.

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The analgesia and the frequency and severity of oxyhemoglobin desaturation related to alfentanil administration were compared in 32 patients randomly selected to receive patient-controlled analgesia (PCA) by either the epidural (EPI) or intravenous (i.v.) route for a mean period of 16 h after major abdominal surgery. Bolus increments of 250 micrograms of alfentanil with a lockout interval of 5 min for i.v. and of 10 min for EPI route were administered by a programmable pump. Oxygen saturation (SpO2) was monitored for 16 h, using a pulse oximeter; data were collected continuously and stored every 30 s via an interface connected to a computer. For the purpose of analysis, SpO2 was divided into six categories: 95%-100%, 90%-94%, 85%-89%, 80%-84%, 75%-79%, and 70%-74%. Both routes provided similar degrees of analgesia at rest and on coughing. Maximum pain relief was obtained earlier in the i.v. group (P < 0.01). The total consumption of alfentanil was 13,141 +/- 3471 micrograms (mean +/- SD) in the i.v. group and 8000 +/- 4213 micrograms in the EPI group (P < 0.001). The effects on SpO2 were not statistically different between the two groups. Cumulative time spent in each saturation category was similar for the EPI and i.v. groups. Severe desaturation episodes, defined as SpO2 < or = 85% for at least 60 s, occurred in 69% of patients in the EPI group and 56% in the i.v. group.(ABSTRACT TRUNCATED AT 250 WORDS)

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