Preoperative autologous blood collection and haemodilution with gelatin solution (gelifundol).

Autologous blood collection and haemodilution with gelatin solution had an effect on the decrease in red blood cells, haemoglobin, haemotocrit, fibrinogen and platelets; however, this technique had no effect on coagulograms, platelet function and haemostasis. In conclusion, this technique is suitable and possibly practical in obtaining sufficient blood for elective surgical patients and is without any undesirable side effects.

A comparative study of isobaric and hyperbaric solution of bupivacaine for spinal anaesthesia in caesarean section.

Though hyperbaric solution of bupivacaine following intrathecal injection had satisfactory spread of analgesia, it regressed rapidly with more side effects. Isobaric bupivacaine seemed to provide a slow regression of analgesia with fewer undesirable effects except for its inadequate spread of analgesia. As a result, if the dosages as well as the time of administration of isobaric solution are well adjusted, we believe that it is safe and reliable with an excellent level of analgesia for caesarean section.

Dental anaesthesia in Siriraj Hospital.

We reported the use of anaesthesia for dental treatment and surgery in 60 patients during September 1989 – December 1990. Most of the pathological indications comprised dental caries, impacted teeth, bone exostosis and infection in the oral cavity. Twenty percent of the patients came to our unit in order to avoid dental treatment under local infiltration with local anaesthetics. Forty-seven percent of patients had associated diseases and 21 percent had taken regular medication. The laboratory investigation is helpful only when was indicated by history and physical examination. A routine complete blood count should be replaced with hematocrit and a routine urine examination should be abandoned. The method of payment for treatment was cash out of pocket 64.9 percent, reimbursement 28.1 percent and financial assistances 7.1 percent, but the fee for anaesthesia had to be reduced because costs of anaesthesia were much more than local infiltration. General anaesthesia was used in 58 patients and intravenous sedation in 2 patients. Monitoring included pulse oximetry, automated blood pressure, EKG, stethoscopy, because the anaesthesiologist and the dentist had to share the airway and the patients had to be ambulatory within a few hours. Anaesthetic time was less than 90 minutes in 81.7 percent of the patients and recovery time was less than three hours in 73.3 percent of them. Only minor complications were noted in recovery time was 13.1 percent and nausea 11.7 percent. Ninety-six percent of the patients were satisfied with the result of treatment under anaesthesia. Therefore, while dental anaesthesia needs the presence of competent anaesthesiologists and close monitoring, it can help dentists in performing their work and overcoming the inconvenience of the patients.

The use of nebulized salbutamol in patients with bronchospasm during anaesthesia: a clinical trial.

The 2.5 mg salbutamol in 2.5 ml normal saline (Ventolin nebules) was used in 22 patients with unexpected bronchospasm via a nebulizer connected to an inspired limb of an anaesthetic machine. Recording of cardiovascular effects, specific notes of breath sound according to symptom severity (clinical lung score), arterial blood gases and airway pressure, was made every 5 minutes up to 30 minutes. The PaCO2 decreased and a/A ratio appeared to increase (improved shunt effect) significantly. However, the cardiovascular effects showed no statistical significance. The airway pressure as well as the clinical lung score appeared to decrease significantly to normal limits 20 minutes after the therapy. We conclude that the use of nebulized beta 2 selective bronchodilator is suitable in the treatment of unexpected bronchospasm without any cardiovascular disturbances.

.5 per cent plain bupivacaine for spinal anaesthesia effects of posture.

0.5 per cent plain bupivacaine following intrathecal injection in the lateral position seems to be lower than that in the sitting position. The dosages of the drug according to the patients' height and the time for injection were shown to yield a desirable spread of analgesia. Provided that strict attention is paid to volume replacement, the technique is safe quick and reliable and provides excellent analgesia. It is satisfactory for use in orthopaedic surgery and abdominal surgery that does not take more than 2 hours.