Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil.

UNLABELLED: Esmolol, a short-acting beta1-receptor antagonist, decreases anesthetic requirements during propofol/N2O/morphine anesthesia. This study was designed to determine whether esmolol affects the volatile anesthetic (isoflurane) required to prevent movement to skin incision in 50% patients (minimum alveolar anesthetic concentration [MAC]) with or without an additional opioid (alfentanil). One hundred consenting adult patients were randomly divided into five treatment groups: isoflurane alone (I), I with continuous large-dose (250 microg x kg(-1) x min(-1)) esmolol (E), I with alfentanil (effect site target of 50 ng/mL) via a continuous computer-controlled infusion (A), A plus continuous small-dose (50 microg x kg(-1) x min(-1)) esmolol (A1), or A plus large-dose esmolol (A2). Anesthesia was induced via a face mask, and steady-state target end-tidal isoflurane concentrations were maintained before incision. The MAC of isoflurane alone was 1.28% +/- 0.13%. Large-dose esmolol did not significantly alter the isoflurane MAC (1.23% +/- 0.14%). Alfentanil alone significantly decreased isoflurane MAC by 25% (0.96% +/-0.09%). Adding small-dose esmolol did not further decrease MAC with alfentanil (0.96% +/- 0.13%). However, large-dose esmolol significantly decreased isoflurane MAC with alfentanil (0.74% +/- 0.09%). Esmolol and alfentanil both significantly reduced the increases in heart rate and mean arterial pressure associated with endotracheal intubation and incision. The mechanism of this effect is unknown. IMPLICATIONS: Most anesthetic techniques rely on a balance of several highly selective medications. The current results define a new anesthetic-sparing effect when volatile anesthetic, analgesic, and beta-adrenergic blocking drugs are combined.

National provision of acute pain services.

In order to determine the degree to which the recommendations of the report of the joint working party on 'Pain after Surgery' by the Royal College of Surgeons of England and the College of Anaesthetists have been implemented, a postal survey was conducted of all hospitals in the United Kingdom where surgery is performed. The number of hospitals with a multidisciplinary acute pain service had significantly increased from 2.8% before September 1990 to 42.7% at the end of 1994. Over the same period there has been an increase in the number of hospitals with a named clinician responsible for acute pain management, from 20 before 1990 to 230 (65.2%) and the number of hospitals with an acute pain nurse has increased from 8 (2.3%) prior to 1990 to 139 (39.3%). Routine assessment of pain and sedation occurs in 82% of hospitals with established acute pain services and in less than 50% of hospitals without an acute pain service. The use of written protocols, the provision of out-of-hours cover and regular training for all staff have increased with time. Research and audit activity related to acute pain management has also improved since 1990.

Sexuality, reproduction, and contraception among residents in obstetrics and gynecology.

OBJECTIVE: To investigate the contraceptive practices and attitudes of residents in obstetrics and gynecology, both personally and professionally. METHODS: We conducted a national survey of obstetrics and gynecology residents. RESULTS: One thousand ninety-one questionnaires (29% of those mailed) were returned, representing 3761 residents in 218 of the 275 programs surveyed. Less than 2% of this population wishing to avoid conception failed to use contraception. The oral contraceptive (OC) pill, the most common current method of contraception (59%), was significantly more prevalent among female residents than among female partners of male residents (P < .001). Condom use was more prevalent among male residents than among partners of female residents (P = .005). When controlled for age, parity, and marital status, and using log linear analysis, gender had a statistically significant impact on the use of several contraceptive methods. Female residents were five times more likely than a comparably educated, nonphysician group of women to use OCs. Twenty-six percent of respondents stated that they would not use the intrauterine device (IUD) personally, but might recommend it to their patients. CONCLUSIONS: Residents in obstetrics and gynecology demonstrate a high prevalence of contraceptive use. Controlling for demographic variables, we found that male and female residents have different attitudes on contraceptive use. Residents believe that OC use is safe and reliable for themselves and their patients, but demonstrate doubt about their own use of an IUD.

Kawasaki syndrome in Wisconsin.

We reviewed cases of Kawasaki syndrome reported to the Wisconsin Division of Health and occurring in Wisconsin residents with illness onsets between 1982 and 1989. Of 164 reports, there were 73 confirmed cases that met the Centers for Disease Control case definition criteria for Kawasaki syndrome, 87 probable cases, and four non-cases. Confirmed cases were reported in residents of all five Wisconsin public health regions. The Wisconsin data was demographically similar to national data: 80% of the cases occurred in children younger than 5 years old, the mean annual incidence rate was highest in children 12 to 23 months of age, males were affected more often than females, and the incidence rate was higher among non-white children than among white children. Coronary artery aneurysms occurred in 16% of the patients with confirmed cases. Males developed aneurysms significantly more often than females, and aneurysm formation did not correlate with age. Kawasaki syndrome continues to occur in Wisconsin, and complete and accurate reporting of the disease will enhance the understanding of its natural history and etiology.