The British National Formulary and many reference textbooks recommend that drug dosages for children be calculated according to body surface area (BSA). Although many rules for drug dosage have been developed, based on age, weight and surface area, none has been accurate and simple enough for routine use. These rules are described, and one for clinical use: up to 30 kg, a child's drug dose may be (wt x 2)% of an adult dose; over 30 kg, (wt + 30)% of an adult dose. If this percentage of an "adult" dose of a drug is used, not only is the BSA curve followed more closely than with the conventional mg kg-1 regimen, but fewer major errors of prescription may be expected.

Aims Multimodal analgesia is thought to produce balanced and effective postoperative pain control. A combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opiates could result in synergistic analgesia by acting through different mechanisms. Currently there are very few parenterally administered NSAIDs suitable for the immediate postoperative period. Therefore, this study was undertaken to assess the analgesic efficacy, relative potency, and safety of parenteral dexketoprofen trometamol following major orthopaedic surgery. Methods One hundred and seventy-two patients elected for prosthetic surgery, were randomized to receive two intramuscular injections (12 hourly) of either dexketoprofen 50 mg, ketoprofen 100 mg or placebo in a double-blind fashion. Postoperatively, the patient's pain was stabilized, then they were connected to a patientcontrolled analgesia system (PCA) of morphine for 24 h (1 mg with 5 min lockout). Results The mean cumulative amount of morphine (CAM) used was of 39 mg in the dexketoprofen group and 45 mg in the ketoprofen group vs 64 mg in the placebo group. (Reduction in morphine use was approximately one-third between the active compounds compared with placebo (adjusted mean difference of -25 mg between dexketoprofen and placebo and -23 mg between ketoprofen and placebo. These differences were statistically significant: P £ 0.0003; 95% CI -35, -14. Painintensity scores were consistently lower with the active compounds, the lowest corresponded to the dexketoprofen-treated patients. Regarding sedation, there were statistically significant differences between the two active compounds and placebo only at the 2nd and 13th hours. Wound bleeding was specifically measured with no statistically significant differences found between all the groups. Conclusions Intramuscular administration of dexketoprofen trometamol 50 mg has good analgesic efficacy both in terms of opioid-sparing effect and control of pain after major orthopaedic surgery.

The dataset necessary to produce reports for anaesthetic training purposes is described, together with appropriate definitions. The format for a standard report that may be used in a logbook is also described. These have been accepted by the Royal College of Anaesthetists. The German Anaesthetic Society (Deutsche Gesellschaft für Anaesthesiologie und Intensivmedizin, DGAI) has accepted the dataset and definitions.

We report the use of extradural diamorphine for postoperative analgesia as a nurse-based service on selected surgical wards in a district general hospital. Eight hundred patients received lumbar or thoracic extradural diamorphine analgesia for postoperative or traumatic pain. Diamorphine was administered in bolus form by suitably trained nursing staff. Satisfactory analgesia, recorded on a verbal rating scale at the conclusion of the service, was achieved in 94.6% of patients. The technique was considered by medical and nursing staff to be a safe and acceptable method of analgesia. Respiratory depression, defined as a ventilatory frequency of less than 10 b.p.m., occurred in seven patients (incidence of 0.9%). All occurred in the theatre recovery area or in the intensive care unit. Retrospectively, each was predictable and all responded to naloxone 0.4 mg.

SummaryThree different dosage regimens of alfentanil were compared with boluses of fentanyl in 80 patients who underwent a variety of surgical procedures. Alfentanil given by infusion at a rate of 7.5 μg/kg/minute for 10 minutes followed by 0.75 μg/kg/minute, was shown to provide a stable anaesthetic which minimises the use of a volatile agent for surgery that lasts more than 45 minutes.

SummaryHypotension induced by nijedipine and chlorpromazine is discussed, together with the role of noradrenaline in the correction of this problem, which was resistant to other forms of therapy. Key wordsComplications; hypotension. Calcium channel blockers; nifedipine. Case historyA 52-year-old man was admitted for elective aortobifemoral bypass graft for occlusive vascular disease and was assessed 36 hours before surgery.He had smoked 40 cigarettes per day for 40 years and had severe chronic obstructive airway disease, for which he received salbutamol and beclomethasone by inhaler. He was also prescribed bendroff uazide for hypertension. Psychiatrists were treating successfully with chlorpromazine a mixed psychiatric problem of schizophrenia and depression. He also took cimetidine and naftidrofuryl oxalate (praxiline). He had shortness of breath on exertion, with exercise tolerance limited to 0.25 mile on the flat, due to intermittent calf claudication. The ECG was normal.The patient was found to have a blood pressure of l85/ 125 mmHg at the pre-operative assessment, but stated that he always became very hypertensive when admitted to hospital. However, the next day his blood pressure always returned to his usual level of 150/80. Examination of the records of his previous three admissions to hospital showed this statement to be correct. Instructions were therefore given for 4-hourly blood pressure measurements, no change in treatment, and, provided his blood pressure decreased to its usual level, surgery.He was premedicated with temazepam 20 mg and metoclopramide 10 mg orally on the morning of surgery in addition to his normal medication. On arrival in the anaesthetic room his blood pressure was 150/95 mmHg. Peripheral venous, central venous and arterial lines were inserted under local anaesthetic. ECG, central venous (CVP) and arterial pressures were on continuous display and the patient was anaesthetised with midazolam 3 mg, fentanyl 250 pg, and vecuronium 8 mg. The blood pressure decreased over several minutes to I10/75 mmHg. Tracheal intubation resulted in an increase in blood pressure to 160/ 95 mmHg. Anaesthesia was maintained with 67% nitrous oxide in oxygen and end-tidal CO, was kept within normal limits. Volatile anaesthetic agents were avoided in view of the expected a-adrenergic block by chlorpromazine. The patient's blood pressure decreased progressively to 85/55 mmHg over the next 10 to 15 minutes. There was no response to intravenous infusion or to skin incision and, as the patient's right heart filling pressure was adequate, a dopamine infusion was commenced via the central venous line to reverse the hypotension. The initial dose was rapidly increased to 25 pg/kg/minute with no effect on the blood pressure. Incremental doses of 1:lO 000 adrenaline were given over the next 10 minutes to a total of 1 mg. There was no change in arterial blood pressure which remained between 60/40 and 80/50 and there was a mild increase in pulse rate to 85 beats/minute.A rapid assessment of possible causes of hypoten...

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