The addition of interscalene block to general anesthesia for patients undergoing open shoulder procedures.

Several studies have demonstrated that interscalene brachial plexus anesthesia alone decreases postoperative pain, nausea, vomiting, urinary retention, and unplanned hospital admissions compared with general anesthesia alone. Anecdotal evidence suggests that an interscalene block combined with general anesthesia decreases unwanted effects of general anesthesia following open shoulder surgery. We compared the effect of combined interscalene block and general anesthesia with general anesthesia alone on Aldrete scores, length of postanesthesia care unit (PACU) stay, verbal rating scale (VRS) pain scores, incidence of postoperative narcotic administration and nausea, and patient satisfaction in a convenience sample of 52 men and women, ASA physical status I, II, or III. Group 1 received standard general anesthesia alone. Group 2 received an interscalene block in combination with general anesthesia using a standard technique. Group 2 had significantly lower VRS scores than group 1 while in the PACU, on the day of surgery, and on postoperative days 1 and 2. Overall satisfaction with the anesthetic technique was higher in the group 2 than in group 1. Results suggest that adding an interscalene block to general anesthesia can be of value in today's outpatient-dominated surgery schedule.

Systemic anaphylaxis immediately following delayed hypersensitivity skin tests.

Delayed hypersensitivity skin tests are performed frequently for other than primary immunologic disorders. Systemic anaphylaxis occurred during delayed hypersensitivity skin testing on a healthy, non-atopic individual. This reaction appeared to be IgE mediated. Anaphylactic recovery sets must be readily available whenever such testing is performed.

The use of beclomethasone diproprionate inhaler complicated by the development of an eosinophilic pneumonia reaction.

As an insoluble steroid aerosol, beclomethasone diproprionate was recently made available in the United States. Only minor complications have been reported previously. A more serious development of adrenal insufficiency may occur upon the improper replacement of systemic steroids. We report on a patient who developed the clinical findings of pulmonary eosinophilia. The possible mechanisms for this complication in out patient are discussed. While a lower systemic steroid dosage may have been the provoking factor, we feel that an adverse reaction to oleic acid, a dispersing agent in the aerosol freon vehicle, is a strong possibility.