Description of a technique for anaesthetizing pregnant ewes for fetal surgery.

General anaesthesia in 12 pregnant ewes undergoing surgery for fetal physiological research was supplemented with an intravenous infusion of remifentanil. This allowed us to employ a lighter plane of surgical anaesthesia and to use intermittent positive pressure ventilation. Our aim was to improve fetomaternal outcome. We monitored maternal pulse, blood pressure, transcutaneous oxygen saturation and end-tidal carbon dioxide levels. Remifentanil doses of 0.75-2.0 microg/kg/min were needed and typically this allowed halothane concentrations of 1-1.5% to be used for maintenance of anaesthesia. Surgery lasted up to 2.5 h. All 12 ewes and their singleton fetuses survived the peri- and postoperative period in good condition.

Pain during awake nasal intubation after topical cocaine or phenylephrine/lidocaine spray.

Although several local anaesthetic techniques are described for nasal analgesia during awake intubation, there has been little attempt to evaluate their effectiveness. We examined pain scores associated with nasal intubation in a randomised cross-over study of 25 volunteers. Local anaesthesia consisted of topical aerosol spray using either cocaine 5% or Co-phenylcaine Forte (a proprietary mixture of phenylephrine hydrochloride 0.5% and lidocaine hydrochloride 5%), followed by lidocaine gel. Topical anaesthesia using an atomiser resulted in incomplete analgesia for insertion of nasopharyngeal airways. Larger diameter tubes resulted in higher pain scores. There was no difference in pain scores between the two drugs.

Prolonged duration of neuromuscular block with rapacuronium in the presence of sevoflurane.

IMPLICATIONS: We report three cases of prolonged paralysis resulting from rapacuronium in the presence of sevoflurane.