Specialist management of routine dental procedures in adults with refractory epilepsy.

Little published information exists about the management of dental treatment procedures for people with epilepsy who, despite their medication, continue to have seizures. This paper draws on relevant literature in neurology and anaesthetics to provide a multi-speciality consensus on methods of assessment and adjunctive treatment options in order to manage the risk of a clinically significant seizure occurring during a procedure. It aims to enhance current guidelines and practice in the provision of specialist care for this diverse group.

'Diprifusor' for neurosurgical procedures.

The pharmacokinetic profile of propofol is an advantage in neurosurgery, where the rapid return of cognitive function is essential for an early postoperative assessment of neurological status. Administration of propofol by 'Diprifusor' target controlled infusion allows induction of anaesthesia in neurosurgical patients without significant reduction of mean arterial pressure or occurrence of apnoeic episodes. This short paper describes our experience of 'Diprifusor' target controlled infusion for neuroanaesthesia in a series of 20 patients undergoing craniotomy for excision of epileptic foci. The results have been compared with ten similar operations where propofol infusion was controlled manually.

Psychiatric comorbidity: prevalence in methadone maintenance treatment.

This study examines prevalence rates for DSM-III-R anxiety and affective disorders in three follow-up samples of opioid addicts who were treated with methadone maintenance. At least one anxiety disorder was diagnosed in 55% of the total sample. Affective disorders were found in 58%. At least one anxiety disorder coexisted with at least one affective disorder in 36% of the sample. The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology. It suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders. It also suggests the need for treatment that focuses on diagnosed mental disorders in addition to drug counseling for the substance abuse disorder.

Methadone maintenance outcome as a function of detoxification phobia.

OBJECTIVE: Methadone maintenance outcome as a function of detoxification phobia was examined. METHOD: Opiate addicts (N = 271) in a 1983 random sample of methadone maintenance patients from three diverse populations were studied. Subjects from an individually assessed follow-up sample (N = 102) were compared on detoxification phobia. Logistic regression analysis yielded best predictors of the phobia. RESULTS: Phobic patients were more likely to be white, female, and abstinent; to have had fewer detoxification attempts and longer periods on maintenance; to show persistence of the phobia; to meet diagnostic criteria for depressive or anxiety disorders; and to have Addiction Severity Index scores above the 75th percentile for psychological problems. CONCLUSIONS: Detoxification phobia has a complex relationship to methadone maintenance outcome. It is associated with greater abstinence for patients in methadone maintenance treatment. However, for rehabilitated phobic patients it presents a barrier to successful detoxification and a drug-free adjustment that is often associated with other psychopathology but could be ameliorated by targeted assessment and treatment.

An unusual complication of tracheal intubation.

We report a previously undescribed complication of tracheal intubation. The complication arose as a result of tracheal intubation performed as an emergency procedure in a patient with an abnormal anteriorly placed larynx. Subsequent corrective laryngeal surgery was required after a temporary tracheostomy had been performed.

Postoperative paraplegia in a patient with an unsuspected dural arterio-venous malformation.

We report a case in which laminectomy was performed in a patient with symptoms attributed to lumbar canal stenosis. The patient developed paraplegia in the early postoperative period. Further investigation revealed a dural arterio-venous malformation. This was treated surgically, producing some neurological recovery. The possible mechanisms for the perioperative deterioration and their implications for anaesthesia are discussed.

Effect of efferent denervation of the vagus nerve on nonadrenergic inhibitory responses obtained from the rat stomach in vitro.

The possibility that antidromic stimulation of afferent nerves is involved in the mediation of nonadrenergic inhibitory (NAI) responses obtained from isolated preparations was tested using the isolated rat stomach--vagus nerve preparation. Unilateral supranodose vagotomies 7-21 days prior to obtaining the preparations permitted efferent denervation to occur and the responses obtained in vitro from stimulation of the sectioned nerves were compared with those from the control nerves. Supranodose vagotomy abolished the responses obtained from the preparations while stimulation of the control nerves gave rise to normal biphasic responses consisting of both excitatory and NAI components. Histological examination of the nodose ganglia revealed the presence of normal sensory ganglion cells while abundant intact axons were observed in nerve trunks on the lesioned side. It is concluded that afferent nerves in the vagus are not involved in the mediation of NAI responses obtained from the rat stomach in vitro.