In this double-blind, randomized, placebo-controlled study, we evaluated the efficacy and safety of different doses of prophylactic IV dexamethasone for postoperative nausea and vomiting (PONV) in 168 children (aged 2-15 yr) scheduled for strabismus surgery. Patients received IV dexamethasone 0.25 mg/kg (D 0.25), 0.5 mg/kg (D 0.5), 1.0 mg/kg (D 1), or saline (S) immediately after induction of general anesthesia. Patients were discharged 24 h after surgery. Nausea and vomiting were assessed at 0-2, 2-6, and 6-24 h after surgery. Blood glucose was measured preoperatively and at 4 h after study drug administration. Wound healing and infection were assessed after 1 wk. More patients in group S had vomiting at 0-2, 2-6, and 6-24 h (P = 0.001, P = 0.003, and P = 0.04, respectively) and required larger doses of rescue antiemetics compared with the dexamethasone groups. Fewer patients in the dexamethasone groups (6, 3, and 6 in D 0.25, D 0.5, and D 1, respectively) had severe PONV compared with group S (P = 0.001). No significant increase in postoperative blood glucose levels was observed and wound healing was satisfactory in all four groups. The results suggest that dexamethasone 0.25 mg/kg is more effective than saline and equally effective compared with larger doses for preventing PONV for pediatric strabismus surgery.

We compared the propofol dose causing loss of verbal response and suppression of bispectral index to 50, between 50 white and 50 black patients, aged 18-65 years. Propofol was administered at 40 mg.kg )1 .h )1 and reduced to 8 mg.kg.h )1 when bispectral index fell to 50. We recorded heart rate and mean arterial pressure for 15 min in total and calculated, for this period, maximal percentage change from baseline for each. A statistician, blinded to patient ethnicity, found mean (SD) propofol dose for loss of verbal response in white and black patients to be 1.41 (0.37) mg.kg change in heart rate were 14.1 (12.6) % and 7.5 (14.0) % (p = 0.015). Other differences were non-significant. The dose of propofol required for loss of verbal response, but not for suppression of bispectral index to 50, is lower in black than in white patients. In the last decade it has been suggested that ethnicity may affect the clinical response to general anaesthetics [1-4], with Caucasian subjects generally shown to be less susceptible to the anaesthetic effects of propofol than other races [1][2][3]. To date, however, the effect of ethnicity on the induction dose of propofol has not been fully investigated. In our earlier study on anxiety and propofol induction [5], we used multivariate analysis to investigate factors independently predictive of propofol dose requirement for loss of verbal response. In doing so, we established that white ethnicity was associated with greater propofol dose requirement than other ethnic groups.To investigate this incidental finding further, we studied a new group of patients using a study design better suited to address specifically the issue of ethnicity. Our aim was to determine whether the induction dose of propofol differs between British patients describing themselves as white and black. Our null hypothesis was that ethnicity does not affect the dose of propofol required to produce loss of verbal response. We also sought to establish whether the initial cardiovascular characteristics of propofol anaesthesia differ between white and black patients. MethodsWith Research Ethics Committee approval and written informed consent, we recruited 269 patients of ASA physical status 1-2, aged 18-65 years, scheduled for surgery under general anaesthesia. We did not study patients who were of neither white nor black ⁄ black

The authors report a case of hypertensive emergency (defined as systolic blood pressure >180 mm Hg and diastolic blood pressure >110 mm Hg with end organ damage) following brachial plexus blockade in a hypertensive lady with unstable angina. The authors describe blocking of baroreceptor reflexes by the local anaesthetic as a putative mechanism and suggest that this potentially serious complication should be considered when planning this particular anaesthetic technique.

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In 2008 McDonnell et al.[1] published a study demonstrating that the transversus abdominis plane (TAP) block reduced morphine requirements following elective caesarean section. Patients in this study received subarachnoid anaesthesia without a long acting opioid. In our unit we use spinal diamorphine for our elective caesarean sections [2]. We wished to establish whether the TAP block should be introduced into our routine practice. MethodsFollowing Research Ethics Committee approval, we recruited 48 elective caesarean section parturients who were randomly assigned to undergo TAP block with either bupivacaine (n = 23) or saline (n = 25). All patients received a spinal anaesthetic with 0.5% heavy bupivacaine and 300 lg diamorphine. On completion of surgery, bilateral TAP blocks were performed under ultrasound guidance. All patients received a loading dose of rectal diclofenac and paracetamol. Standard postoperative analgesia comprised regular diclofenac and paracetamol, and subcutaneous morphine on request. A blinded investigator assessed each patient postoperatively 2, 6, 24 and 48 h postoperatively. ResultsThere were no statistically significant differences in postoperative morphine requirement (Fig. 1) or visual analogue pain scores between the two groups. The incidence of side effects was similar. DiscussionThe TAP block does not improve analgesia following elective caesarean section under subarachnoid block with intrathecal diamorphine. The multimodal analgesic regimen used in our unit means that routine implementation of the TAP block for elective caesarean section would not be beneficial. Dose response to intrathecal diamorphine for elective caesarean section and compliance with a national audit standard.