A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.

Current trends in orthopaedic surgery have explored different forms of adjuvant treatments to minimize postoperative pain and the risk of nausea and vomiting. A small single preoperative dose of dexamethasone, as part of a comprehensive multimodal analgesic regimen in low-risk patients undergoing total hip arthroplasty (THA), provides antiemetic and opioid-sparing effects but the longer-term effects on pain, complications, or function are not known. We therefore asked whether such a routine would affect longer-term pain, complications, or function. Fifty patients undergoing elective primary THA using spinal anesthesia were initially randomized to receive either dexamethasone (40 mg intravenous) or saline placebo. The patients, anesthesiologists, nurses, and research coordinators were blinded to the study arms. The functional outcome was measured using the Harris hip score. Outcomes were assessed 6 weeks and 1 year postoperatively. We observed no difference in resting pain between the two groups at either time period.

Accepted for publication 8th April, 1993 widely implemented, particularly in young women for idiopathic scoliosis. As this generation of women approaches child-bearing age, it is not uncommon for them to present to the obstetric anaesthesia team. Indeed, the need for anaesthesia for operative delivery is even more likely in these patients than in normal parturients.Previous reports on this subject have focused on considerations in achieving successful epidural anaesthesia. 2-5 At our institution, spinal anaesthesia is more often employed for both elective and urgent operative delivery. We describe the successful use of and advantages of this technique in a patient with Harrington fusion. Case reportA 33-yr-old G2P1 patient presented for elective repeat Caesarean delivery at 38 wk gestation. She had received a uneventful epidural anaesthetic for her first operative delivery. Subsequently, she had undergone Harrington rod placement and iliac bone grafting for worsening idiopathic scoliosis while in her teens. The course of her pregnancy had been uneventful. Aside from her surgical history her preoperative anaesthetic review revealed a 165 cm, 85 kg woman with a normal airway. Her only symptom was occasional back pain during her pregnancy. She could not recall the extent of her spinal fusion and old x-rays were not available. However, she had a midline back scar extending down to the level of L 5 and another scar over her left iliac crest.She consented to spinal anaesthesia after explanation of its advantages and potential difficulties. After intravenous hydration with one L warmed Ringer's lactate, she was placed in the right lateral decubitus position and her back was prepared aseptically. After multiple unsuccessful attempts via both the midline and paramedian approaches at the L3_ 4 level with a 25 g Whitacre needle and 21 g introducer, a successful dural puncture was made on the first attempt at the rnidline of the Ls-S 1 interspace.Clear CSF was obtained and 15 mg bupivacaine 0.75% in aqueous dextrose 8.25% was injected. With the patient turned immediately supine and placed in 15 ~ Trendelenburg, a T 6 level of anaesthesia was obtained within CAN J ANAESTH 1993 / 40:7 / pp 667-9

We conclude that the TheraCath, because of the removable stylet, provides effective electrostimulation of the epidural space. Its use was simple and devoid of complications. Nonetheless, further studies are required before implementing its routine use in clinical settings.

We believe that the subdural hematoma and not the EBP was the cause of the seizures. Earlier recognition of confusion and fatigue as a postictal state may have led to earlier diagnosis of the hematoma. Our experience suggests that EBP be avoided in the setting of subdural hematoma.

Anesthesiologists must be confident that the information they receive is accurate in the context of rapidly changing clinical status. Our results show that the RP405 analyzers produce reliable measurements.

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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