Sevoflurane with nitrous oxide provides satisfactory anesthetic induction and intubating conditions; however, induction using sevoflurane without nitrous oxide is associated with a high incidence of patient excitement and prolonged time to intubation. There were greater decreases in heart rate and systolic blood pressure during induction with halothane than with sevoflurane; however, these differences may be dose-related. The more rapid emergence with sevoflurane when compared with halothane is consistent with the low solubility of sevoflurane in blood and tissues. Children receiving sevoflurane for up to 9.6 MAC-hours did not develop high serum fluoride concentrations.

To determine the minimum time interval between oral midazolam (0.5 mg" kg -~) Accepted for publication 16th April, 1993. prdmddication (valeur de base), au moment de la sdparation et pendant I'application du masque facial h l~nduction de I'anesthisie. Nous avons trouv~ que les changements de friquence cardiaque et de pression artdrielle systolique ont dtd semblables clans les trois groupes au cours de notre dtude. Le niveau de sddation d la sdparation et l'application du masque a dtd plus dlev~ que la valeur de base et n'est pas diffdrent entre les trois groupes. Le niveau d'anxiolyse n'a pas vari~ de la valeur de base d aucun moment dans les trois groupes. Nous concluons que les enfants peuvent ~tre sdpard de leurs parents aussi prdcocdment que 10 minutes aprds avoir re~u 0,5 mg" kg -1 de midazolam par voie oral.Oral midazolam is safe and effective for premedication of children scheduled for ambulatory surgery. 1.2 It has a rapid and reliable onset of action, few side effects and does not delay recovery. McMillan et al. demonstrated that oral midazolam in doses of 0.5, 0.75 and 1.0 mg-kg -1 produced excellent sedation and anxiolysis scores 15 min after administration to children 1-6 yr and at the time of separation from parents at 30 min. I However, the ease of separation from parents was assessed at only one time, 30 min after oral midazolam premedication. Similarly, Weldon et al. recommended that oral midazolam be given 30-45 min preoperatively) It has been our experience, however, that children could be separated from their parents less than 30 rain after receiving oral midazolam without compromising the degree of sedation and anxiolysis. We therefore sought to determine the minimum time interval between administration of oral midazolam (0.5 mg. kg -l) and separation of the children from their parents that would ensure a smooth and calm separation. MethodsThis randomized study was approved by the Human Subjects Review Committee and written parental consent was obtained. Midazolam (0.5 mg-kg -I) was administered to 30 children, ASA I or II and aged 1-6 years, who CAN J ANAESTH 1993 / 40:8 / pp 726-9

This paper presents the results of a step-by-step Delphi analysis used to develop a definition and measure of quality of working life [QWL] in a case specific setting. A representative panel of 64 employees from the headquarters of a large insurance company constituted the Delphi panel that engaged in defining QWL utilizing a six-phase Delphi methodology. The results of a 34-item QWL questionnaire developed from that definition were tested with a sizable [n = 450] sample of the company's employees. Those results identified the following seven significant predictors of QWL, four of which extended beyond specific job content: [a] degree to which my superiors treat me with respect and have confidence in my abilities, [b] variety in my daily work routine, [c] challenge of my work, [d] my present work leads to good future work opportunities, [e] self-esteem, [/l extent to which my life outside of work affects my life at work, and [g] the extent to which the work I do contributes to society.

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Introduction Anesthesia-related activities contribute to operating room waste impacting climate change. The aim of this study was to ascertain 1) the current existence and scope of department and education programs concerned with anesthesia ''green'' practice; and 2) perceived barriers to environmental sustainability efforts among Canadian anesthesia department chiefs and residency program directors. Methods Associationof Canadian University Departments of Anesthesia-affiliated anesthesiology department chiefs (n = 113) were invited to complete an online survey ascertaining current efforts in, and barriers to, environmentally sustainable anesthesia practice. Similarly, Canadian anesthesiology residency program directors (n = 17) were invited to complete an online survey delineating current educational programs on environmental sustainability and identifying interest in, and barriers to, developing a Canada-wide curriculum. Results The response rates for department chiefs and program directors were 23% (26/113) and 41% (7/17), respectively. Department chiefs indicated that their departments participate in sustainability efforts such as donating medical equipment (65%) and recycling (58%). Despite interest in environmental sustainability, department chiefs identified inadequate funding (72%), lack of a mandate (64%), and inadequate knowledge (60%) as barriers to implementing environmentally sustainable practices. Only 29% of responding Canadian anesthesiology programs include environmental sustainability in their curriculum. Responding residency program directors believe residents would benefit from more teaching on the topic (86%) but identified barriers including a lack of faculty expertise (100%) and time constraints (71%). Respondents (71%) also indicated an interest in developing a Canadian curriculum on the topic. Conclusion Our results highlight current attitudes, gaps, and barriers to environmentally sustainable anesthesiology practice among departmental and educational leadership. Furthermore, this study identifies potential opportunities to

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Mark Levine MB FRCPCPurpose: To compare the maintenance and recovery characteristics after sevoflurane with those after propofol in children with epidural blockade. Methods: F~cy unpremedicated, children ASA I-II, 2 -8 yr of age, scheduled for elective urological surgery as outpatients, were randomly allocated to receive either: I) sevoflurane for induction and maintenance of anaesthesia or 2) propofol for induction (2-3 mgkg -~ iv) and for maintenance (5-I0 mg-kg -t-hr -l iv). All children received N20 70% in oxygen before induction and throughout the anaesthetic, rocuronium for neuromuscular blockade and a lumbar or caudal epidural block before incision. Heart rate (HR), systolic blood pressure (SBP), recovery times and all side effects during maintenance and recovery were recorded by a blinded observer. Adverse events during the first 24 hr were also recorded. Results: Mean HR increased 5-10% after induction in both groups reaching a maximum by five minutes. Heart rate returned to baseline by skin incision in the sevoflurane group and by I0 min after induction in the propofol group. During maintenance, HR decreased by 10-20% below baseline values by 20 min in the propofol group only, where it remained for the remainder of the anaesthetic. Similarly, SBP increased by 10% after induction of anaesthesia in both groups, but returned to baseline by I 0 min. Light anaesthesia occurred in four (16%) children, all in the propofol group. Emergence and recovery indices were similar in the two groups. Discussion: Sevoflurane and propofol exhibit similar maintenance and recovery profiles when combined with epidural analgesia in children undergoing ambulatory surgery. Objectif : Comparer les caract~ristiques du maintien et de la r&up~ration de l'anesth&ie apt& l'administration de s~voflurane avec celles de l'anesth&ie apr~s le propofol chez des enfants qui ont subi un blocage p~ridural. M~thode : Cinquante enfants ASA I-II, ~g~s de 2 ~ 8 ans, qui n'ont re~u aucune premeditation, devaient subir une chirurgie urologique ~lective ambulatoire et ont ~t~ r~partis au hasard pour recevoir soit : I) du s~voflurane pour rinduction et le maintien de l'anesth&ie, ou 2) du propofol pour rinduction (2-3 mg'kg "~ iv) et de I'anesth&~e, du rocuronrum pour le blocage neuromuscula~re et une anestheste p~ndurale Iomba~re ou caudale avant rincision. La fr~quence cardiaque (FC), la tension art&ielle systolique (TAS), le moment de la r&up&ation et tousles effets secondaires pendant le maintien et la r&up~ration de I'anesth&ie ont ~t~ enregistr& par un observateur impartial. On a aussi not~ les &~nements ind~sirables pendant les 24 prerni~res h. R6,sultats : La FC moyenne a augment~ de 5-I 0 % apr& I'induction de I'anesth&ie dans les deux groupes eta atteint sa valeur maximale en cinq minutes. Elle est revenue ~ sa valeur de base Iors de rincision cutan& darts le groupe s~voflurane et en dix minutes apr& rinduction darts le groupe propofol. Pendant le maintien de ranesth&ie, la FC a diminu~ de 10-20 % sous sa valeur de base en 20 min dans le...