Double-blind comparison of extradural block with three bupivacaine-ketamine mixtures in knee arthroplasty.

We have compared 0.5% bupivacaine 75 mg (group A; n = 15) with three 0.5% bupivacaine 75 mg-ketamine mixtures for extradural block in 59 ASA I-III patients undergoing total knee replacement in a randomized, double-blind study. The following doses of preservative-free 1% ketamine were used: 0.3 mg kg-1 (group B: n = 14); 0.5 mg kg-1 (group C: n = 5); and 0.67 mg kg-1 (group D: n = 15). Level of sensory block, degree of motor weakness and sedation scores were recorded before and after operation. Duration of postoperative analgesia was also noted. There was no difference between groups in median maximum level of sensory block (group A: T4 (range T10-T2); group B: T4 (T10-T2); group C: T4 (T8-T2); and group D: T3 (T8-C3)) or in the degree of motor block. Thirty-three of the 44 patients who received ketamine showed signs of systemic absorption (blurred vision, sedation) within 10 min of injection. There was no significant difference between groups in median duration of analgesia (group A: 240 (range 115-340) min; group B: 198 (97-460) min; group C: 150 (122-448) min; and group D: 210 (130-390) min). No patient suffered any adverse psychomimetic effects. We conclude that at the doses used, addition of ketamine to extradural bupivacaine did not improve extradural block in adult patients undergoing total knee replacement.

Anaesthesia for caesarean section in a patient with systemic amyloidosis secondary to familial Mediterranean fever.

The anaesthetic management of a 33-year-old primigravid woman at 29 + 5 weeks' gestation with familial Mediterranean fever (FMF), secondary amyloidosis, renal allograft with deteriorating renal function and cardiac impairment for emergency caesarean section is described. Pathophysiology and management options are discussed. Cautious induction of epidural anaesthesia together with continuous invasive monitoring produced a good outcome for mother and baby.

Anaesthesia for appendicectomy in childhood: a survey of practice in Northern Ireland.

A postal questionnaire was sent to all members of the Northern Ireland Society of Anaesthetists to determine current practice in anaesthesia for children with acute appendicitis. Respondents were asked to describe their usual practice in such cases. They were also asked about the occurrence of complications due to the use of suxamethonium, and for their views on the use of rocuronium in such cases. Few major differences in anaesthetic technique were demonstrated. 74% of consultants and 84% of trainees always perform a rapid sequence induction for appendicectomy. However 15% of consultants do not feel that this is necessary. Only 6% of consultants and 6% of trainees would normally use rocuronium, with the majority still preferring suxamethonium. Only 28% of consultants and 20% of trainees see rocuronium as a possible alternative to suxamethonium in these cases, although others expressed increasing concern over the use of suxamethonium in children. There was wide variation in the type of intra-operative and post-operative analgesia prescribed, with less than one third of consultants and trainees using combinations of opioids, local anaesthetics and non-steroidal anti-inflammatory drugs.

The role of the teaching hospital. A survey of paediatric anaesthetic techniques used by trainee anaesthetists on a regional training scheme.

All trainee anaesthetists on the Northern Ireland training scheme were surveyed about the techniques they use when anaesthetising elective paediatric cases. We compared the practice of doctors with specialist paediatric training to that of others and discovered that trainees with specialist training were more likely (p less than 0.05) to admit parents during induction, but were less likely (p less than 0.05) to visit their patients pre-operatively and routinely to use suxamethonium. Other general findings were confusion over the re-use of halothane and extensive involvement of trainee anaesthetists in neonatal resuscitation.