Prevention of sports-related eye injury.

Sports-related eye injury is an important cause of vision loss. Many eye injuries can be prevented through the supervision of play, the enforcement of game rules and the use of eye protective devices. State-of-the-art eye protective devices incorporate highly impact-resistant optical material, usually polycarbonate lenses, in a sturdy frame. Protective devices are available for use in racquet sports, baseball, basketball, football, ice hockey and other sports.

Retinal vasculopathy associated with systemic light chain deposition disease.

A 35-year-old black male with the abrupt onset of blurred vision and decreased visual acuity was found to have severe retinal vasculopathy associated with systemic light chain deposition disease. While ocular manifestations are frequently reported in other plasma cell dyscrasias; ophthalmologic symptoms have not been previously reported in systemic light chain deposition disease alone. A possible mechanism of light chain deposition and damage to the retinal vasculature is proposed.

Recovery after single-breath halothane induction of anaesthesia in daycase patients. A comparison with thiopentone.

A single-breath technique of inhalational induction of anaesthesia allows intravenous induction agents to be avoided. We have investigated recovery from anaesthesia in 40 daycase patients, using tests of psychomotor function. Patients anaesthetised with inhalational induction awaken earlier than those who receive thiopentone, but not significantly earlier. There were no significant differences in postoperative psychomotor function between patients who received thiopentone and those who had inhalational inductions. Single-breath halothane, nitrous-oxide, oxygen induction is an alternative to intravenous induction in cooperative adults, but does not confer significant benefits in terms of recovery.

Effects of preoperative fasting on morbidity and gastric contents in patients undergoing day-stay surgery.

The effects of overnight fasting on gastric contents and on the symptoms associated with fasting were studied prospectively in female outpatients. Group A (n = 66) were patients scheduled for first trimester therapeutic abortion; group B (n = 66) were scheduled for minor gynaecological surgery. It was demonstrated that overnight fasting (15 +/- 3 h) did not guarantee an empty stomach (volume 22 +/- 13 ml) and that gastric acidity was high (pH 1.6 +/- 0.5). Gastric volumes and pH were the same in both groups. Group A patients had a higher incidence of preoperative nausea and vomiting (P less than 0.001). Before anaesthesia, 50% of all patients had symptoms of moderate to severe hunger, while 44% of patients had symptoms of moderate to severe thirst. Neither the severity of symptoms of fasting nor the duration of fast correlated with gastric volume or pH. Patients in group A had significantly greater symptoms of hunger; however, they also had fasted for significantly longer (P less than 0.002).

The role of H2 receptor antagonist premedication in pregnant day care patients.

In a randomised study of 132 pregnant outpatients, the effect on gastric volume and pH of oral premedication with a single dose of an H2 antagonist was investigated. Either cimetidine 400 mg (n = 33), or ranitidine 150 mg (n = 33), were given 90 to 120 minutes before scheduled surgery. Mean pH was significantly higher in cimetidine (5.0) and ranitidine (5.2) groups, and mean volume was significantly lower in cimetidine (13.2 ml) and ranitidine (11.1 ml) groups compared with 66 untreated patients (pH 1.6, volume 22.1 ml). A gastric pH less than or equal to 2.5 was found in 97 per cent of unpremedicated patients and 35 per cent of these patients also had a gastric volume greater than or equal to 25 ml. Eighty-three per cent of patients received their premedication within 75-200 minutes of surgery. Patients premedicated within that range had a significantly lower incidence of either a gastric pH less than or equal to 2.5 or a volume greater than or equal to 25 ml (p less than 0.01). Both cimetidine and ranitidine significantly reduced the number of patients with these risk factors. Four patients, however, in the cimetidine group had both a pH less than or equal to 2.5 and a volume greater than or equal to 25 ml. Pharmacological manipulation of the gastric environment does not prevent aspiration and clearly cannot be substituted for careful airway management and vigilance on the part of the anaesthetist. However, premedication of pregnant outpatients with a single, oral dose of an H2 antagonist is a simple, inexpensive, safe and effective way of reducing the risk of a severe aspiration pneumonitis.

Internal jugular catheterisation in small children. The use of a posterior approach.

Internal jugular catheterisation, using a posterior approach, was attempted in 50 infants and children aged from 1 day to 12 years, weighing 1.25 to 30 kg. Thirty-five of the patients weighed less than 10 kg. Catheterisation was successful in 49 cases. Initial catheter position was satisfactory in 48 of the 49 cases and satisfactory pressure waveform and flow characteristics were achieved in all 49 cases. There were no complications attributable to the technique. The technique proved reliable and easily learnt and is recommended as a particularly suitable approach to central venous catheterisation in small children.