SummaryA 31-year-old woman had an elective Caesarean section under combined spinallepidural anaesthesia. At the end of the operation, diarnorphine 2.5 rng in 5 rnl of 0.25% bupivacaine plain was injected through the epidural catheter. Forty minutes after this, the patient had a cardiorespiratory arrest in an ordinary postnatal ward.

Target controlled infusion of ketamine as analgesia for TIVA with propofol I~.,'po~: To determine the accuracy of a target controlled infusion system for ketamine and to assess its suitability for the provision of analgesia when used in conjunction with a propofol infusion in spontaneously breathing patients. Methods: Nineteen, adult, ASA I-II patients scheduled for elective surgery were studied. After premedication with 20 mg temazepam an appropriate plasma concentration of ketamine was selected and, when the target controlled infusion (TCI) system indicated that this had been achieved, anesthesia was induced and maintained using a propofol infusion. The plasma ketamine concentration was measured at predetermined intervals and cardiovascular and respiratory parameters recorded at 10 min intervals. Patients were reviewed in recovery and 24 hr postoperatively to assess the adequacy of their recovery and the presence of any undesirable side effects. ~ults: The TCI system had a median performance error against predicted plasma concentrations of 18.9% (SE 2.5%) and a median absolute performance error of 23.3% (SE 2.3%). Divergence was 20.3% (SE 30. I%) and wobble was 12.9% (SE 2. 1%). There was a mean decrease in arterial pressure of 6.4% (SD 19.7%) and a mean increase in heart rate of 4.3 % (SD 17.4%). Little respiratory depression occurred and all patients made a rapid postoperative recovery with none describing unpleasant dreams or hallucinations. Concision: The TCI system provided a clinically acceptable degree of control of the plasma ketamine concentration although some further improvement should be possible by amending the pharmacokinetic model. Clinically the combination with a propofol infusion proved to be a satisfactory anesthetic technique.

There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013NCDs ( -2020. It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

Summary Changes in intra -

We have determined the effective dose of eltanolone (pregnanolone) required to induce anaesthesia in 30 ASA I and II patients aged 60 yr and over. Eltanolone 4 mg ml-1 was administered at a rate of 300 ml h-1 (group 1), 600 ml h-1 (group 2) or 1200 ml h-1 (group 3) until loss of consciousness, as judged by loss of verbal contact with the patient. Anaesthesia was induced successfully in all patients. The slower rates of induction were associated with a significant increase in induction time (ANOVA, P < 0.01) and a decrease in the induction dose (P < 0.01). There was a significant reduction in systolic arterial pressure after induction of anaesthesia in groups 2 and 3 (MANOVA, P < 0.01). This study suggests that the induction dose of eltanolone in unpremedicated older patients should not exceed 0.6 mg kg-1.

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