Comparison of propofol versus thiopentone with midazolam or lidocaine to facilitate laryngeal mask insertion.

PURPOSE: To assess the ease of insertion of laryngeal mask airway (LMA) comparing propofol with lidocaine or midazolam followed by thiopentone and compare the costs with each technique. METHODS: One hundred and fifty ASA 1 or 2 patients equally divided into three groups scheduled for elective surgery were recruited into this prospective, single blind, randomized, parallel groups study. Anaesthetic induction was achieved with 1 microgram.kg-1 fentanyl i.v. followed by either 2.5 mg.kg-1 propofol (group P), or a sequence of 1.5 mg.kg-1 lidocaine and 5 mg.kg-1 thiopentone (group LT), or midazolam 0.1 mg.kg-1 and, three minutes later, 5 mg.kg-1 thiopentone (group MT). The LMA was inserted by the blinded anaesthetist who assessed and graded the conditions for LMA insertion and noted any adverse responses (i.e., inadequate jaw relaxation, gagging, coughing, limb or head movement, hiccough and laryngospasm). Conditions were considered "excellent" if there were no adverse responses, and "satisfactory" if such a response was mild and transient. RESULTS: Excellent or satisfactory conditions were observed in 48 (96%) patients in the midazolam-thiopentone group, 46 (92%) in the propofol group, and 34 (68%) in the lidocaine-thiopentone group (P = 0.0001). The incidence of gagging (P = 0.042), limb movement (P = 0.031), and laryngospasm (P = 0.0001) was higher in the lidocaine-thiopentone group. CONCLUSIONS: With the above doses, a fentanyl-midazolam-thiopentone combination which is about 35% less expensive than fentanyl-propofol, provides equally good conditions for the insertion of LMA.

Anxiety levels following anaesthesia for day-case surgery. A comparison of state anxiety levels following induction of anaesthesia with propofol or thiopentone.

The effect of different induction agents on postoperative state anxiety levels was investigated. Propofol produces statistically significant lower levels when compared with thiopentone. This finding suggests that propofol should remain the drug of choice for short duration anaesthesia.

Emery-Dreifuss muscular dystrophy.

Emery-Dreifuss syndrome is a rare form of muscular dystrophy associated with cardiac complications that lead to sudden death. The disorder and its potential anaesthetic implications in the management of a patient who presented for orthopaedic surgery is described.

Acute viral myocarditis. A death associated with anaesthesia.

The death of a 35-year-old woman in the immediate postoperative period as a result of undiagnosed acute viral myocarditis is described. The presentation, diagnosis and course of the disease is discussed. It is recommended that wider use to be made of routine electrocardiographs as a screening test.

Confidential professional reports. A method of assessing the career progress and prospects of anaesthetic senior house officers.

A proforma is described which is used at 6-monthly intervals to assess the professional progress of anaesthetic senior house officers. The administration of a reporting system as part of the career counselling process is outlined, and its potential for determining the future prospects of junior staff is discussed.

Spinal analgesia for transurethral prostatectomy. Comparison of plain bupivacaine and hyperbaric lignocaine.

Plain 0.5% bupivacaine and hyperbaric 5% lignocaine were compared for spinal analgesia in 100 patients undergoing transurethral prostatectomy (TURP). The time of onset, height of blockade, degree of hypotension, and blood loss were similar in both groups. The duration of blockade was considerably greater in the bupivacaine group, resulting in a significant reduction in the requirement for postoperative analgesia.

Ketamine and military anaesthesia. The effect of heavy papaveretum premedication and Althesin induction on the incidence of emergence phenomena.

An anaesthetic technique suitable for military field anaesthesia was sought which would attenuate the psychic side effects of ketamine. Heavy premedication with 30 mg of papaveretum and induction of anaesthesia with Althesin were evaluated. A combination of the two lowered the incidence of side effects, but they still occurred frequently enough to pose problems. Ketamine sequelae are considered incompatible with the battlefield environment.

The effect of naloxone on pentazocine induced hallucinations.

A case of pentazocine induced hallucinations which responded to treatment with Naloxone is reported.

Comparison of the frequency of muscle pain associated with suxamethonium in pre- and post-ovulatory women and in those taking a combined oral contraceptive pill.

The frequency of muscle pain following the use of suxamethonium was compared in pre- and post-ovulatory women and in those taking a combined oral contraceptive pill. There were no statistically significant differences between the groups. It is suggested that serum concentrations of progestogen were too low to produce the protection against suxamethonium pains reported in late pregnancy.

PIP: 98 healthy women aged 16-40 undergoing minor surgery warranting tracheal intubation were included in a study to determine whether small fluctuations in serum progestogen concentration which occur during the normal menstrual cycle, or the concentrations achieved during use of a combined oral contraceptive (OC) pill, affected the frequency of muscle pain in young women following the use of suxamethonium. The women had regular menstrual cycles and were free of systemic illness or past history of any illness or drug use affecting hormonal status and were not breastfeeding or pregnant within 3 months. Women not taking the pill were classified as pre- or postovulatory according to their menstrual history, while those taking OCs were divided into 2 groups according to the progesterone activity of the preparation. A standard anesthetic technique was used. Premedication was with pethidine and atropine, anesthesia was induced with thiopentone, and immediately after loss of the lash reflex, suxamethonium was given. Anesthesia was maintained with halothane and nitrous oxide in 30% oxygen. All patients commenced mobilization on the day of surgery. Patients were interviewed the next day about their experience of muscle pain. The patients in each group were well matched regarding their physical characteristics and the surgery performed. The overall frequency of pain attributable to suxamethonium was 61%. The frequency of muscle pain and pain scores in the pre- and postovulatory women were almost identical. There were no statistically significant differences between the other groups. Serum concentrations of progestogen were probably too low to produce the protection against suxamethonium pain reported in late pregnancy.

Postoperative dreaming. A comparison of the incidence following pentazocine and morphine premedication.

The incidence of postoperative dreaming following the use of morphine and pentazocine as premedicants in an otherwise standard anaesthetic sequence is compared in healthy volunteers. No statistically significant difference was demonstrated between the two drugs. The causes of psychotomimetic problems in the postoperative period and the difficulty of precise definition of hallucinations are discussed.

An evaluation of a pre-operative anaesthetic assessment questionnaire.

A total of 400 patients was invited to complete a pre-operative anaesthetic assessment questionnaire. On analysis 74.3% had undergone a previous general anaesthetic, 60.8% had taken some form of medication in the preceding 6 months, and 53.8% gave a significant medical history. The questionnaire is designed to focus attention on those patients at risk, to allow more efficient use of the time available for the pre-operative visit, and to provide a permanent record of the patient's medical history relevant to anaesthesia.

Total intravenous anaesthesia. A technique based on alphaxalone/alphadolone and pentazocine.

Two hundred and eight patients were anaesthetised using incremental doses of intravenous alphaxalone/alphadolone (Althesin). Analgesia was provided by supplements of pentazocine, which also helped eliminate the excessive movements associated with pure Althesin anaesthesia. This is a total intravenous technique and consequently eliminates the problem of atmospheric pollution. It provides adequate anaesthesia for most minor surgical procedures.