Local anaesthetic infiltration for surgical exodontia of third molar teeth: a double-blind study comparing bupivacaine infiltration with i.v. ketorolac.

We studied 40 patients undergoing surgical removal of at least two third molar teeth under general anaesthesia. Patients were allocated randomly to one of two groups: group B (n = 20) received bupivacaine up to 2 mg kg-1, infiltrated around the inferior alveolar nerves bilaterally, and group K (n = 20) received ketorolac 10 mg i.v. at the start of surgery. There were no significant differences between the two groups in postoperative pain scores measured at 1 h using a visual analogue scale. Group K had a significantly lower incidence of side effects related to intraoral anaesthesia. Swallowing, speech and oral continence were significantly better. Group K scored higher for overall patient satisfaction, measured using a visual analogue scale. We failed to demonstrate any difference in early postoperative recovery (coughing, laryngospasm, stridor or arterial oxygen desaturation) between the groups. We conclude that the use of 0.5% bupivacaine infiltration was no more effective than a single 10-mg injection of ketorolac while giving rise to a higher rate of "minor" airway complications and lower patient acceptability.

The reinforced laryngeal mask airway for dento-alveolar surgery.

We have evaluated the reinforced laryngeal mask airway (LMA) for use during dento-alveolar surgery in 100 ASA I and II day-case patients allocated randomly to receive either a nasotracheal tube or reinforced LMA. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In addition, a fibreoptic assessment was made of laryngotracheal soiling, and the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway positioning or perioperative oxygen desaturation. Nineteen patients in the nasotracheal tube group had epistaxis (P = 0.001) and laryngotracheal soiling occurred in three of these patients. Two reinforced LMA were dislodged on moving into the operating theatre and in a further five patients in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by downward pressure on the mandible by the surgeon. There were no differences in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.

Effect of antagonism of mivacurium on recovery of extraocular muscle function.

We have measured extraocular muscle function in 41 patients who received neuromuscular block with mivacurium 0.2 mg kg-1 during anaesthesia with propofol, ketorolac, fentanyl and isoflurane in nitrous oxide and oxygen, which was antagonized at the end of surgery with neostigmine 0.05 mg kg-1 and glycopyrronium 0.01 mg kg-1 in 21 of these patients. Extraocular muscle function was measured before and after surgery in each group with the Maddox Wing apparatus and compared with a control group (n = 20) who breathed spontaneously the same gaseous anaesthetic mixture via a reinforced laryngeal mask airway. In patients where the action of mivacurium was antagonized, extraocular muscle function was improved significantly 20 min after antagonism (P < 0.001) compared with those who received no antagonism. At 60 min after antagonism, there were no differences between the groups. There were no differences between patients who received no neuromuscular blockers and those who received blocker and antagonist.

The quantitative evaluation of acute lung injury.

The lung represents a complex barrier between air and blood. Subtle changes in the permeability of this barrier can be brought about by injury and only later do they become clinically and radiologically detectable. Techniques using radioactive traces offer a way of quantifying the degree of lung injury and so will aid the development of new forms of therapy.