Education and training in anaesthesia--revised guidelines by the European Board of Anaesthesiology, Reanimation and Intensive Care.

The expansion of the European Union during the last 2 yr has resulted in the need for a revision of existing guidelines to further harmonize education and training in the specialty of anaesthesiology throughout the European Union. Although each individual country is responsible for its own training and certification, these guidelines are intended to reflect minimum criteria for specialist training. It is the opinion of the Section and Board of Anaesthesia that specialist training will need to be for a minimum of 5 yr.

The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5%.

BACKGROUND: The incidence of TNS after spinal anaesthesia is a problem. Especially the use of hyperbaric lidocaine in patients placed in the lithotomy position during surgery has been associated with a high incidence of TNS. The present study was performed to investigate whether TNS is present more frequently in patients undergoing surgery in the supine position with use of hyperbaric lidocaine compared with hyperbaric bupivacaine. METHOD: Seventy patients were included and randomised to receive either hyperbaric lidocaine or hyperbaric bupivacaine. All patients were contacted on the first and third postoperative days by an anaesthesiologist blinded to the local anaesthetic used. The patients were asked about symptoms of TNS, pain not associated with the operation area, and asked to grade the complaints after a verbal analogue score from 0 to 10. RESULTS: We found a total of ten patients who showed signs of TNS. There were nine patients in the lidocaine group (26%) who showed signs of TNS compared to only one patient in the bupivacaine group (3%) (P<0.01). The average score of TNS complaints was 3.5. A total of 13 patients (19%) complained of back pain. There were no significant differences with regard to which local anaesthetic was used. The average score of back pain was 3.3. CONCLUSION: TNS is a significant problem in patients having spinal anaesthesia with hyperbaric lidocaine compared to hyperbaric bupivacaine, both in the supine position. For day-case surgery, TNS would start after dismissal from hospital. The use of hyperbaric lidocaine is therefore questionable, even though these problems are of an order that the majority of patients would still choose spinal anaesthesia for future operations.

[Pericarditis and inflammatory bowel disease]. / Pericarditis og inflammatorisk tarmsygdom.

Extraintestinal manifestations of ulcerative colitis and Crohn's disease are well described in the literature. These may be diagnosed before, concomitantly or after the diagnosis of the specific type of inflammatory bowel disease. Between 25% and 36% of patients with either type of IBD will have at least one extraintestinal manifestation. Pericarditis and myocarditis are rare, but potentially serious complications. We report one such case.

[Doping--a medical problem in Denmark?]. / Doping--et medicinsk problem i Danmark?

Misuse of drugs in relation to doping has been known for many years in Denmark. The Sports Confederation of Denmark carries out about 1000 doping controls every year on athletes at both competitions and training-sessions. In the period 1991-1996, 5084 doping controls were performed. Six athletes who refused to participate were excluded from organized sport for a period of two years. Forty-three athletes were found positive for drugs; 32 were positive for androgenic-anabolic steroids, 11 were positive for different stimulants including amphetamine, cocaine, caffeine and ephedrine. The misuse of drugs outside organized sport is considered to be a growing problem. Three percent of all persons between fifteen and fifty years have tried some kind of doping. The number of misusers of androgenic-anabolic steroids in Denmark is considered to be around 10,000. Side-effects are numerous and include cardiovascular side-effects, psychiatric disturbances and hepatotoxicity. It is important that all doctors be aware of the side-effects and health problems in misusers.

Reduced cardiac reserve in amiodarone-treated pigs after cardiopulmonary bypass and cardioplegic arrest.

An animal model was designed for blinded study to elucidate whether cardiac pump failure after heart surgery in amiodarone-treated patients is due to interference between the drug and the surgical procedures. Seventeen adult pigs were treated with amiodarone for 30 days (study animals, 1,400 mg/day, n = 9; untreated control animals, n = 8) followed by exposure to cardiopulmonary bypass and topical cold cardioplegic arrest (Bretschneiders solution) for 60 min. Apart from 1 g of calcium, no inotropic agents were administered. Cardiac reserve was tested by ventricular pacing (200 beats/min for 30 min or until exhaustion). No difference in hemodynamic status was observed between the treated and the untreated group before pacing. Pacing duration in the amiodarone-treated pigs was 10 +/- 3 versus 22 +/- 4 min in control pigs (p less than 0.05). Only one amiodarone-treated pig survived 30 min of pacing compared with five control pigs (11% vs. 63%, p less than 0.05). The following variables differed significantly in the two groups during pacing: cardiac output, left ventricular pressure, arterial pressure and peak positive and negative first derivative of left ventricular pressure (dP/dt). Most marked were the changes in peak positive dP/dt, indicating a compromised systolic function. The two groups did not differ in preload or afterload at any time during the experiments.