We conclude that ultrasonography may have a potential role to facilitate insertion of epidural catheters in patients with scoliosis.

We performed a double-blind, placebo-controlled study to evaluate the different methods of administering droperidol in patients using patient-controlled analgesia (PCA) with morphine. Eighty patients undergoing major orthopedic procedures received temazepam 0.2 mg/kg orally followed by induction of general anesthesia with propofol 2.5 mg/kg, fentanyl 2 micrograms/kg, and vecuronium 0.1 mg/kg. Anesthesia was maintained with nitrous oxide, oxygen, and enflurane. At the end of surgery, all patients received PCA with morphine (0.5 mg/mL, bolus dose 1 mg, and lockout interval 5 min. Before commencement of PCA, patients were randomized to receive droperidol 1.25 mg immediately and, in addition, droperidol 0.16 mg with each PCA dose (Group 1), droperidol 1.25 mg immediately (Group 2), droperidol 0.16 mg with each PCA dose (Group 3), and no droperidol (Group 4). Incidence of nausea and vomiting, request for rescue antiemetics, sedation score, and side effects were recorded every 4 h. Droperidol significantly reduced the incidence of postoperative nausea and vomiting (PONV) (P < 0.01) and request for rescue antiemetic (P < 0.01) compared to placebo. However, there was no difference in the incidence of PONV between droperidol given either as a single dose at the end of surgery (Group 2) or mixed in morphine PCA (Group 3). The addition of droperidol in PCA after an initial dose (Group 1) should be avoided, as it resulted in more sedation and no further reduction in the incidence of PONV compared to Groups 2 and 3.

This study examined the hypothesis that headache after general anesthesia is related to a caffeine withdrawal state. Two hundred eighty-seven patients undergoing minor elective procedures under general anesthesia were studied. Four to six hours after anesthesia each patient completed a questionnaire assessing his or her own alcohol, tobacco, and caffeine consumption, and the occurrence of postoperative side effects. A highly significant difference was found between the caffeine consumption of patients with and without preoperative (P = 0.0035) and postoperative (P less than 0.0001) headache. Logistic regression analysis of trend between headache and caffeine consumption suggested that with each 100-mg increase in caffeine consumption, there was a 12% increase in the odds of headache developing in the immediate preoperative period (P less than 0.0066) and a 16% increase in the odds of postoperative headache developing (P less than 0.0001). No relationship was found between headache and the patients' age, sex, usual frequency of headache, consumption of alcohol or nicotine, or the anesthetic agents or adjuvants used. It is concluded that postoperative headache is related to caffeine intake and that this relationship is explained, at least in part, by a perioperative caffeine withdrawal syndrome.

We present the anaesthetic and surgical management, and post-operative course of a patient with osteogenesis imperfecta which exemplifies the problems associated with this condition. The observed petechial haemorrhagic rash is not characteristic of the bleeding tendency in osteogenesis imperfecta nor characteristic of acute disseminated intravascular coagulation. Despite potential life-threatening complications the patient made a good recovery and was discharged 3 weeks after surgery.

Spinal motor evoked potentials (SMEP) were recorded from tibialis anterior muscle after epidural stimulation of the spinal cord at the low cervical or high thoracic level during scoliosis surgery. By using a double stimulus pulse to produce temporal summation within the spinal cord a maximal CMAP response was readily achieved despite good surgical anaesthesia.

Midazolam was used for anaesthesia in 20 patients undergoing cardioversion; 10 received flumazenil, which caused immediate rapid reversal of anaesthesia, and these patients maintained SpO2 greater than 95%, breathing air, within 5-10 min. In contrast, patients in the placebo group were still partially sedated and required oxygen therapy for up to 2 h to maintain a normal SpO2. Arterial pressure, but not heart rate, also was greater in the flumazenil group in the recovery period.

No abstract

Summary Posterior spinal fusion for correction of scoliosis is a major procedure for which the provision of satisfactory, safe postoperative analgesia is often a problem. One possible solution involves the placement of epidural catheters under direct vision by the surgeon at the end of the procedure, followed by an epidural infusion of local anaesthetic with or without an opioid. Despite its simplicity, this technique has not been reported as being consistently successful. We report an observational study of the analgesia achieved with surgically placed epidural catheters and of the reasons for the failure of the technique. Fourteen consecutive patients undergoing posterior spinal fusion had epidural catheters placed by the surgeon and had radio‐opaque dye injected down the catheter 15 min before their routine postoperative chest X‐ray. Analgesia was assessed at 0, 6, 12 and 24 h after surgery using visual analogue scores. Five patients had inadequate pain control; none of these patients had dye visible in the epidural space. Seven patients had dye visible in the epidural space; all of these cases had satisfactory analgesia. In two cases, dye was observed in the paravertebral gutters; both of these patients had satisfactory postoperative analgesia. This small pilot study suggests that correctly placed ‘surgical’ epidural catheters are capable of providing good analgesia after posterior spinal fusion and that misplaced catheters, seen in a large proportion of patients, are associated with inadequate analgesia.