Anaesthesia for non-cardiac surgery in the post-cardiac transplant patient.

As survival and quality of life continue to improve for cardiac transplant recipients, the number of patients with functioning heart transplants who present for surgery continues to increase. The conditions for which surgery may be required, the specific problems relating to anaesthesia and the necessary measures which should be taken to ensure an uncomplicated clinical course are discussed. A clear understanding of the physiology and pharmacology of the denervated heart is essential for these patients to undergo safely anaesthesia and surgery.

Effects of preoperative methoxamine on blood loss and haemodynamic variables during transurethral prostatic resection under spinal anaesthesia.

Thirty-six patients who presented for transurethral prostatic resection were allocated randomly to one of two groups. Patients in group A were given methoxamine 10 mg i.m., 15 min before spinal anaesthesia. Patients in group B acted as a control group. All patients received spinal anaesthesia. Preoperative administration of methoxamine 10 mg i.m. decreased blood loss significantly and improved haemodynamic stability compared with the control group.

Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches.

Forty-five patients undergoing circumcision were allocated randomly to one of three study groups to compare topical analgesia with dorsal nerve block using the midline or lateral approach. Pain scores, side effects and analgesic requirements were recorded after surgery. Patients who received topical analgesia required significantly more fentanyl and had higher pain scores at the 15-min observation period after operation. Fentanyl requirements and pain scores were similar in patients who received a dorsal nerve block using either the midline or lateral approach. The incidence of side effects after surgery was similar in all three groups.

Intrathecal morphine in the treatment of chronic intractable pain.

Fifteen patients with intractable pain received intrathecal morphine delivered via a programmable (Medtronic) device. In twelve patients the pain was due to cancer and three patients had pain of non malignant origin. All of the patients reported excellent or good relief. A total of 14 complications were reported in 7 patients. Most of these were minor and related to surgical or mechanical problems. One patient with pain of non malignant origin developed serious complications which required the removal of the infusion device. The results of this study show that chronic intrathecal infusion of morphine is superior to conventional forms of analgesia in patients with intractable pain of malignant origin. We would advise that it should remain a therapy of last resort in patients with intractable non malignant pain as the long term side effects are still unknown and the potential for serious side effects still exists.

Decompression sickness in Ireland--a review.

In the last decade there has been an increase in the incidence of decompression sickness in Ireland. The modern diver, equipped with specially developed diving equipment, is exposed to abnormal physiological conditions. This has resulted in a spectrum of medical conditions, which need to be recognised, diagnosed and treated. The department of Underwater Medicine at University College Hospital, Galway, is the only referral centre in the Republic of Ireland for patients suffering from decompression sickness. Early recognition and referral for treatment dramatically improves patient outcome. A one year's review of patients referred for treatment is presented.

Delayed profound respiratory depression after premedication with trimeprazine.

Delayed, profound respiratory depression occurred in a 4-year-old boy, who had been premedicated with trimeprazine 4 h after tonsillectomy. This is a rare, but potentially fatal idiosyncratic reaction.