Arnold-Chiari malformation and pregnancy.

Chiari (or Arnold-Chiari) malformations are a continuum of abnormalities of the hindbrain with the possibility of disordered cerebrospinal fluid flow and craniospinal pressure gradients. We describe the management of a 30-year-old primigravida who presented following a grand mal seizure during the first trimester. A Chiari type I malformation was diagnosed radiologically. She was delivered at term by elective caesarean section using a general anaesthetic technique. The difficulties in anaesthetising the patient with Chiari malformation are considered, and a literature review is presented to illustrate the risk-benefit analysis undertaken.

Benign metastasising leiomyoma: a rare cause of breathlessness following caesarean section.

We describe the case of a 31-year-old patient with pregnancy-induced hypertension who became breathless following an emergency caesarean section performed at 31 weeks' gestation. Initially, it was thought her symptoms were due to pulmonary oedema as a result of fluid overload, but there was little improvement with diuretic therapy. Further investigations revealed a diagnosis of benign metastasising leiomyoma, a rare condition associated with uterine fibroids but not often seen in association with pregnancy. The differential diagnosis and management are discussed.

Evaluation of the Level 1 Hotline blood warmer.

The Level 1 Hotline warmer is a new type of fluid warmer, developed specifically for use with low flows. It was found to be effective at flows between 1 ml.min-1 and 75 ml.min-1.

Ketorolac for postoperative analgesia in elderly patients.

Ketorolac was compared with papaveretum followed by paracetamol plus dextropropoxyphene orally, for postoperative pain relief in elderly orthopaedic patients. Seventy-two patients over the age of 65 years were entered into a double-blind, randomised trial. Pain and pain relief were recorded during an intramuscular and an oral phase, lasting up to 8 days, and a global assessment was made at the end of the study. No difference was demonstrated between the two treatment groups. The incidence of side effects was similar in both groups. It was concluded that ketorolac could provide pain relief equivalent to papaveretum for many patients.

Comparison of intramuscular ketorolac and morphine in pain control after laparotomy.

Ketorolac, a prostaglandin synthetase-inhibiting analgesic, was compared with morphine for relief of pain after laparotomy for gynaecological surgery. Eighty patients were studied; they were given either ketorolac 30 mg intramuscularly followed by 10 mg 4-hourly as required, or morphine 10 mg intramuscularly 4-hourly as required, administered in a double-blind, randomised fashion. Pain scores (verbal and visual analogue) were recorded at baseline and assessed at 30 and 60 minutes and then hourly for 6 hours. Pain relief was measured at the same times. Pain and pain-relief scores were further assessed on the evening of day 1 and at 24 hours. Pain scores were similar in the two groups but pain-relief scores were better in the morphine group. A considerable number of patients suffered postoperative nausea and vomiting but there was no difference between the groups. One patient in the ketorolac group had unexplained hypotension. It is concluded that ketorolac can provide effective postoperative analgesia.