No abstract

Summary Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml. kg−1 of 0.25% bupivacaine with 0.25 mg. kg−1of preservative‐free ketamine, group B received 1 ml. kg−1 of 0.25% bupivacaine with ketamine 0.5mg. kg−1 and group C received 1 ml. kg−1 of 0.25% bupivacaine with 1 mg. kg−1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 7.9h in group A, 11 h in group B and 16.5 h in group C. There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.

Sixty boys, aged 1-10 yr, undergoing orchidopexy were allocated randomly to receive one of three solutions for caudal extradural injection. Group A received 0.25% bupivacaine 1 ml kg-1 with adrenaline 5 micrograms ml-1 (1/200,000), group C received 0.25% bupivacaine 1 ml kg-1 with clonidine 2 micrograms kg-1 and group K received 0.25% bupivacaine 1 ml kg-1 with ketamine 0.5 mg kg-1. Postoperative pain was assessed using a modified objective pain score and analgesia was administered if this score exceeded 4. The median duration of caudal analgesia was 12.5 h in group K compared with 5.8 h in group C (P < 0.05) and 3.2 h in group A (P < 0.01). There were no differences between the groups in the incidence of motor block, urinary retention or postoperative sedation.

SummaryWe have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.Keywords Anaesthetic techniques, regional; epidural, thoracic. Surgery ; coronary artery bypass grafts. Complications ; postoperative. ...................................................................................... Correspondence to: Dr N. B. Scott Accepted: 2 March 1997 In recent years there has been a growing interest in the use of thoracic epidural anaesthesia for coronary artery bypass surgery. Its potential advantages include excellent analgesia [1], improved pulmonary function [2], early tracheal extubation [2, 3] and cardiac protection as a result of sympathetic blockade [4]. Thoracic epidural anaesthesia decreases the stress response to sternotomy and cardiopulmonary bypass. Increased sympathetic activity may lead to an increase in arterial pressure, tachycardia and an imbalance between the myocardial oxygen demand and supply, with increased myocardial oxygen extraction and the possibility of ischaemic episodes. Moore et al. showed that plasma concentrations of adrenaline and noradrenaline did not increase in the first 24 h after cardiac surgery in patients receiving thoracic epidural anaesthesia compared with a conventional anaesthetic technique [5]. Other studies have shown that haemodynamic stability was maintained during and after surgery using thoracic epidural anaesthesia [6][7][8][9].Thoracic epidural anaesthesia has been shown to decrease pain and improve the endocardial to epicardial blood flow ratio, thereby decreasing the number of ischaemic episodes [10][11][12]. Thoracic epidural anaesthesia has also been shown to decrease infarct ...

A previously undiagnosed case of myotonic dystrophy presenting with apnoea of 2.5 h duration following thiopentone is described. A review of the anaesthetic outcome from 49 operations in 17 patients with myotonic dystrophy in the Aberdeen area is presented. The type of operation and intra- and postoperative problems are analysed. The results reveal a 52% complication rate in previously diagnosed cases and a 35% complication rate in undiagnosed cases. In the series, 29% of the anaesthetics were administered to symptomatic patients before formal diagnosis. To avoid potential hazards it behoves the anaesthetist to remain alert to the possibility of the undiagnosed disease. The symptomatology and associated findings of the 17 patients at initial diagnosis are presented. The literature has been reviewed and anaesthetic implications noted.

We undertook a double-blind study to evaluate equianalgesic doses of intramuscular morphine sulphate (0.15 mg.kg-1) and codeine phosphate (1.5 mg.kg-1) in 40 healthy children undergoing adenotonsillectomy. There were no significant differences in pain scores, analgesic requirements or sedation scores between the two groups over the following 24 h. More children vomited in the morphine group (60%) than the codeine group (30%) between one and six h after the procedure (P < 0.05). Codeine phosphate is associated with less postoperative vomiting than morphine sulphate while providing comparable postoperative analgesia for adenotonsillectomy.

The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. A secondary increase in GST concentration, at 24 h, was seen in a small number of individuals who received halothane or enflurane. Abnormal GST concentrations were found in 50% of patients following halothane anaesthesia, 20% following enflurane and 11% after isoflurane. The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.

There is a significant increase in EtCO(2) in children undergoing thoracoscopy, which is higher than during laparoscopy. Changes in EtCO(2) are larger in smaller children undergoing single-lung ventilation. Thoracoscopy may preserve intraoperative thermoregulation.