Effect of a eutectic mixture of local anaesthetic agents (EMLA) on tourniquet pain in volunteers.

We studied the effects of EMLA on tourniquet pain in 10 healthy male volunteers. The tourniquet inflation time which was tolerated was significantly longer with EMLA (46.4 (SEM 3.5) min) compared with placebo (37.5 (2.7) min) (P less than 0.05). Linear analogue pain scores increased in both groups over the study period, but were significantly less in the EMLA group at 40 min (P less than 0.05). We conclude that tourniquet pain has a significant cutaneous component.

'Fruit-flavoured' mask for isoflurane induction in children.

The effect of disguising the odour of isoflurane with fruit flavouring, upon the quality of inhalational induction, was studied in 41 children aged 3-10 years in a double-blind, randomised trial. Facemasks were either lightly coated with fruit extract or moistened with water so that their appearance was identical to children, anaesthetist and observer. Children allocated to receive fruit flavouring were significantly quieter than the placebo group, but their degree of movement during induction was unchanged. The incidence of respiratory complications including breath-holding, laryngospasm and coughing was similar in both groups. Overall impression of the quality of induction as assessed by the anaesthetist showed no difference between the groups. This simple, cheap modification of inhalational induction warrants further appraisal while the case for disguising the odour of isoflurane remains unproven.

Oxygenation during electroconvulsive therapy. A comparison of two anaesthetic techniques.

Oxyhaemoglobin saturation was monitored continuously during electroconvulsive therapy in two groups of patients. All patients were anaesthetised using methohexitone (40-100 mg) and suxamethonium (25-50 mg). In group 1 (n = 48), the patients' lungs were ventilated manually with oxygen in air (40-50%) during the modified convulsion. In group 2 (n = 47), the convulsion was allowed to subside before recommencing manual ventilation with a similar gas mixture. Eight patients in group 1 and seven patients in group 2 received more than one shock and were excluded, leaving 40 patients in each group. In group 1, one patient had a minimum oxygen saturation of less than 90% after the electric shock as opposed to 11 in group 2 (p less than 0.01). Five of the patients in group 2 had a saturation of less than 80%. It is concluded that patients undergoing electroconvulsive therapy should be ventilated with an oxygen-enriched gas mixture during the convulsion induced by the electric shock in order to avoid hypoxaemia.

Anxiety levels in junior anaesthetists during early training.

Trait anxiety levels (predisposition to anxiety) and personality profiles were recorded in four novice anaesthetists prior to the start of their training in anaesthesia. State anxiety (the extent of anxiety at the moment of testing) was also assessed before and after the transition from accompanied to solo anaesthetic practice. There was no demonstrable difference in anxiety scores as a result of 'going solo' in any subject.

A comparative study of diazepam with sustained-release diazepam as oral premedication in minor gynaecological surgery.

Sixty patients undergoing elective minor gynaecological surgery received oral pre-operative medication with 10 mg diazepam in either conventional tablet form on the morning of operation or as the sustained-release tablet the night before. Subjective and objective assessments of the effectiveness of premedication were made. Patients receiving sustained-release diazepam on the night before surgery experienced fewer periods of wakefulness than those who received placebo. Patients who were given diazepam on the morning of surgery felt more drowsy pre-operatively than those who received sustained-release diazepam the night before.

Comparative study of two long-acting tranquillizers for oral premedication.

Lorazepam 2.5 mg was compared with promethazine 50 mg as oral premedication in a double-blind study in women. The premedication was given at the same time to all patients on each operating list, and both drugs continued to be effective 6 h after ingestion. A similar number of patients considered each drug to have relieved anxiety and the amnesic effect of lorazepam was confirmed. However, the use of lorazepam alone was accompanied by significantly more salivation during and after anaesthesia than the use of promethazine, especially in patients in whom the trachea was intubated. There was also a higher frequency of vomiting during and after operation with lorazepam (seven of 67 patients) than after promethazine (one of 71 patients). Promethazine produced dyskinetic side-effects in six of 71 patients.