Changes in intra-ocular pressure during general anaesthesia. A comparison of spontaneous breathing through a laryngeal mask with positive pressure ventilation through a tracheal tube.

Changes in-intra-ocular pressure during spontaneous ventilation with a laryngeal mask were compared with controlled ventilation using a tracheal tube in 40 patients undergoing intra-ocular surgery under general anaesthesia. Intra-ocular pressure was measured before induction, after establishing the airway, at the end of the operation and after removal of the airway device. Anaesthesia was induced with propofol and maintained with enflurane and nitrous oxide in oxygen. Mean end-tidal carbon dioxide tension was significantly higher during spontaneous ventilation than during controlled ventilation 5 min after establishing the airway (5.7 versus 4.5) and at the end of surgery (6.1 versus 4.2) (p < 0.001). Despite this, intra-ocular pressures were lower than baseline and similar in the two groups throughout anaesthesia. At the end of surgery, intra-ocular pressure (mmHg) was 11.2 and 8.6 during spontaneous or controlled ventilation respectively. One min after removal of the device, mean intra-ocular pressure (mmHg) in the tracheal tube group (16.0) was slightly higher than baseline (15.3) and was significantly higher than the laryngeal mask group (10.9) (p < 0.01). Spontaneous ventilation with a laryngeal mask is an acceptable alternative to controlled ventilation with tracheal intubation in elective intra-ocular surgery.

The polyurethane nasotracheal tube.

An uncuffed nasotracheal tube for use in minor maxillofacial surgery has been developed using polyurethane. The suitability of this tube as an alternative to the existing soft red rubber and harder polyvinyl chloride materials has been assessed at four centres during anaesthesia for routine oral surgery. The tube was found to be satisfactory.

Use of high-performance liquid chromatography-thermospray mass spectrometry and gas chromatography-electron-impact mass spectrometry in the identification of the metabolites of alpha-methylacetohydroxamic acids, potential anti-asthmatic agents.

Two potential anti-asthmatic alpha-methylacetohydroxamic acids, compound 1 and compound II were metabolised to two major products (metabolite 1 and metabolite 2) after oral dosing to rabbits. Metabolite 1, extracted under acid conditions from the plasma and urine of dosed animals, was identified as a glucuronide by incubation with beta-glucuronidase and subsequent high-performance liquid chromatographic-mass spectrometric (HPLC-MS) analysis of the aglycone. HPLC-MS analysis of metabolite 2 suggested that it was the acetamide, however, unequivocal identification was obtained by further analysis using gas chromatography-mass spectrometry (GC-MS) of its trimethylsilyl derivative and by comparison with the mass spectra of the authentic acetamides. This study shows the advantages of combining HPLC-MS with other techniques such as GC-MS for the identification of metabolites.

Blood glucose concentrations in children undergoing outpatient dental anaesthesia.

Fifty-six children, aged between 2 and 16 yr, undergoing dental extractions under general anaesthesia had their plasma glucose concentrations estimated before surgery. The mean concentration was 3.80 mmol litre-1. The lowest value was 2.2 mmol litre-1 in spite of starvation for 16.5 h. It is possible that outpatients are less susceptible to hypoglycaemia.

Early days of anaesthesia in sheffield.

An account is given of the early days of anaesthesia in Sheffield with reference to articles published in local newspapers.

Recovery comparison between enflurane and halothane techniques. A study of outpatients undergoing cytoscopy.

A comparison of recovery from either halothane or enflurane with nitrous oxide and oxygen after induction with Althesin by outpatients in a cystoscopy clinic is presented. The recovery rate was scored by the recovery room nurses, who were ignorant of which agent had been used. Recovery after enflurane was quicker than after halothane.

Underlying immunopathology as a cause of adverse responses to two intravenous anaesthetic agents.

A patient who had shown some evidence of immunological sensitivity underwent several operations under general anaesthesia for otitis media without ill effect. On his second exposure to Althesin, however, he suffered a severe reaction. Facial angioneurotic oedema was accompanied by peripheral vasodilatation and sweating, and C3 conversion was observed in his plasma. Subsequent anaesthetics produced no reactions until four years later, when thiopentone and suxamethonium were given. This reaction was much milder, but C3 conversion again occurred. Although the clinical signs indicated an anaphylactoid reaction, the laboratory findings suggested that this patient had an underlying immunopathological condition involving complement activation, which could be triggered by any intravenous agent that activated complement. The judgment that a reaction to a particular drug is anaphylactic cannot be made on the basis of clinical signs alone. Simple laboratory analysis will show whether the reaction is due to an underlying immunopathological condition that may be triggered by any of several drugs.