Day case laparoscopy. A comparison of two anaesthetic techniques using the laryngeal mask during spontaneous breathing.

Forty women undergoing day case laparoscopy were randomly allocated to receive either an inhalational or total intravenous anaesthetic. All patients breathed spontaneously through a Brain laryngeal mask. There were no clinically significant cardiovascular or respiratory differences between the two techniques. No episodes of clinical aspiration occurred and there were no peri-operative arrhythmias. We conclude that spontaneous respiration with a laryngeal mask is a safe and effective method of anaesthesia for laparoscopy provided certain guidelines are followed.

The efficacy of pre-operative controlled-release indomethacin in the treatment of post-operative pain.

A double-blind, placebo-controlled study in patients undergoing lumbar laminectomy was carried out to assess the morphine-sparing effect of a controlled-release indomethacin formulation ('Flexin Continus' tablets, 75 mg). Thirty patients were randomly allocated to receive 1 tablet of active or placebo study medication pre-operatively and their pain scores on visual analogue scale (VAS) and their morphine consumption, delivered by Patient Controlled Analgesia (PCA), were recorded over the 24-hour post-operative period. Over the first 4-hour post-operative period, the patients who had received active treatment reported less pain on VAS than those in the placebo group and this difference was statistically significant on recovery (p = 0.033) and at 1 hour post-recovery (p = 0.013). By 4, 8, 12 and 24-hours post-recovery the mean cumulative amount of morphine used by patients in the active treatment group was reduced by 25%, 23%, 37% and 30%, respectively, compared to the control group. At the 12-hour time point, the difference in morphine consumption approached statistical significance (p = 0.074). It is concluded that the pre-operative administration of controlled-release indomethacin reduces post-operative morphine requirements and significantly reduces VAS pain scores on recovery.

Oral fluids prior to day surgery. The effect of shortening the pre-operative fluid fast on postoperative morbidity.

One hundred day surgical patients undergoing first trimester termination of pregnancy were randomly allocated to receive either 150 ml of clear fluid 1.5-2 hours before anaesthesia or to remain fasted from midnight the night before. Patients were anaesthetised using a total intravenous technique which consisted of propofol and alfentanil. No adverse intra-operative events were noted in either group. There were no significant differences in immediate recovery time, or pain, nausea and headache scores at 30 or 120 minutes following recovery. The fasted group had less pain (p less than 0.05) at 60 minutes after recovery than the fluid group, although the mean pain scores in both groups were low. Eighty two per cent of the patients returned questionnaires about pain, nausea and headache scores on arriving home, and at 12 and 24 hours after surgery. There were no significant differences between the two groups. In conclusion, pain, nausea and headache scores are low following total intravenous anaesthesia with propofol and alfentanil for termination of pregnancy and these were unaffected by the administration of 150 ml of clear fluid given approximately 1.5 hours pre-operatively.

The anaesthetic record: a confidential survey on data omission or modification.

A confidential survey was conducted among medical practitioners in New Zealand with a stated interest in anaesthesia to ascertain the proportion of those currently engaged in anaesthetic practice (thought to be approximately 325), who knowingly omit or alter undesirable physiological parameters from the anaesthetic record. Two hundred and forty-five replies were received from currently active anaesthetists. The reported frequency of occasional data omission or falsification was 55%. Those anaesthetists who intentionally manipulated data were more likely to be dissatisfied with their current anaesthetic record form, to view the record as an intraoperative distraction and less likely to perceive the record as being important for the use of future anaesthetists. There was no correlation between data manipulation and concerns over the medicolegal uses of the record.