Post-operative analgesia following femoral-neck surgery--a comparison between 3 in 1 femoral nerve block and lateral cutaneous nerve block.

A prospective controlled randomized trial on patients receiving surgery for fractured neck of femur was carried out, in which post-operative analgesic requirements in three separate groups were compared. Patients in Group 1 acted as controls, whilst those in Groups 2 and 3 received lateral cutaneous nerve blocks and 3 in 1 femoral nerve blocks, respectively. Patients in Group 3 needed significantly less analgesia than the other two groups, and the time to first administration of analgesia was significantly longer. No complications of either of the nerve blocks was noted.

Guillain-Barré syndrome mimicking brainstem death.

There must be a defined, predisposing condition to fulfil the criteria of brainstem death in the UK. A patient presented recently in coma and with absent brainstem reflexes, but no diagnosis was initially obvious. A subsequent diagnosis of Guillain-Barré syndrome was made, and the patient made a full recovery.

The M1 air crash. The demands placed on anaesthetic and intensive care services of two hospitals.

The M1 air crash provided an enormous challenge to the anaesthetic and intensive care services of the hospitals which admitted the survivors, many of whom had serious injuries. This account describes some of the problems which were encountered in two of the hospitals, details the workload imposed on the anaesthetists and the staff of the Intensive Therapy Units and identifies factors which, if improved, might advance the management of multiple casualties admitted from the scene of a major disaster.

Caudal anaesthesia for postoperative pain relief in children: a comparative trial of different regimens using plain bupivacaine.

A comparative trial between three different dosage regimens of bupivacaine administered by the caudal route, used for the prevention of postoperative pain in children undergoing elective inguinal herniotomy or ligation of patient processus vaginalis was undertaken. The regimens compared were bupivacaine 0.25% (1 ml/kg), bupivacaine 0.25% or 0.5%: (Age (years +2)/10 ml per dermatome to be blocked. This being calculated for inguinal surgery to be Age (years) + 2 ml. A linear analogue pain scale was used to evaluate pain, all three regimens being found to produce excellent analgesia, there being no significant difference between the pain scores of the three groups. Time to onset of analgesia, as indicated by changes in intraoperative heart rate in response to surgical stimulation were also similar in all groups. No evidence of postoperative motor weakness or disturbance of bladder function was found and there were no symptoms or signs attributable to local anaesthetic toxicity.

Evaluation of blood loss during suction termination of pregnancy: ketamine compared with methohexitone.

Blood loss during suction termination of pregnancy was estimated in patients anaesthetised with intravenous ketamine (n = 25) and compared with those anaesthetised with intravenous methohexitone (n = 25). Both groups received midazolam 0.15 mg/kg intravenously 3 min prior to induction of anaesthesia. No statistically significant difference was found in blood loss between the two groups (P = 0.66). There was no incidence of dreaming or psychomotor disturbances with ketamine in our study.

PIP: This study compared blood loss associated with suction termination of 1st-trimester pregnancy in 25 women anesthetized with intravenous ketamine and 25 women who received methohexitone anesthesia. Both groups were given 0.15 mg/kg of midazolam intravenously 3 minutes before anesthesia induction. There was no significant difference in blood loss between the 2 groups. The mean blood loss was 85.7 ml in the methohexitone group and 79.5 ml in the ketamine group. The unpleasant dreams, delirium, and psychomotor disturbances previously reported to be associated with use of ketamine were not observed in this study, presumably because of the administration of midazolam. However, 12 of the women in the ketamine group experienced postoperative nausea and 6 of them vomited, compared with only 1 in the methohexitone group. Although there was no correlation between anesthesia and blood loss, blood loss was significantly greater with increasing gestational age. It is concluded that ketamine does not offer any advantage over methoheitone in terms of blood loss during suction abortion. If ketamine is to be used for this procedure, routine use of an antiemetic should be considered to counteract the high incidence of nausea and vomiting.