Patients'attitudes to rectal drug administration

One hundred adult patients attending for day case surgery were surveyed by anonymous questionnaire in order to determine their attitudes to rectal drug administration. Fifty four patients did not want an analgesic drug (diclofenac sodium) administered rectally whilst under anaesthesia, all preferring to take it orally if available. Ninety eight patients thought that drugs administered per rectum should always be discussed with them beforehand and a few had very strong feelings about this route of administration. We suggest that prescribers of rectal diclofenac should always discuss it with patients pre-operatively. Whilst many are happy to have suppositories, some young patients are sensitive about this and prefer to take such medication by mouth.     

Anaesthesia for Cockayne's syndrome. Contemporary solutions to an old problem

The management of a failed intubation in a nineteen-year-old patient suffering from Cockayne's syndrome is described. Use of a laryngeal mask prevented major anaesthetic morbidity. Tracheal intubation was subsequently facilitated by a fibreoptic bronchoscope passed through the laryngeal mask. Cockayne's syndrome is reviewed including recent important developments in its aetiology and pathogenesis.;     

Etomidate infusion in thoracic anaesthesia

An etomidate infusion was used in the place of nitrous oxide during one lung anaesthesia for 40 patients undergoing thoracic surgery. Analgesia was provided by fentanyl. A mixture of oxygen and air was used to maintain arterial oxygen tension within normal limits despite one lung anaesthesia and enabled the use of nitrous oxide to be avoided in several patients who had lung cysts. Recovery was fairly rapid (mean (SEM) 11.5 (1.4) minutes). There was no incidence of awareness or dreams. This technique provides satisfactory anaesthesia and oxygenation during thoracic surgery when one lung only is being ventilated.     

Phenelzine poisoning

A 46-year-old female with severe phenelzine poisoning was managed successfully by alpha blockade and fluid loading, with the aid of invasive haemodynamic monitoring. The pathophysiology was documented, showing elevated plasma and urinary catecholamines, cardiovascular abnormalities and a contracted blood volume. Most of these changes were reversed following treatment.     

Audit in transfusion practice

Given the growing concern for the safety, cost and adequacy of blood supply, there is an increasing need for appropriate blood product utilization. Despite a number of consensus guidelines for the transfusion of allogeneic blood products, inappropriate blood transfusion continues. We discuss the quality assurance process for improvement in transfusion therapy including audit of blood transfusion. Audits identify areas of problems in transfusion practice which can be corrected by education of doctors, formulation of practice guidelines and algorithms. To improve the effectiveness of the audit programmes, the frequency of audits has to be maintained and there should be continual reinforcement of policies.     

In Vivo Effects of Dexmedetomidine on Laser-Doppler Flow and Pial Arteriolar Diameter

Background: The alpha2 -adrenergic agonist dexmedetomidine alters global cerebral blood flow (CBF). However, few studies have investigated the action of dexmedetomidine on the cerebral microcirculation. This investigation examined the effects of dexmedetomidine on (1) regional CBF in the rat cerebral cortex using laser-Doppler flowmetry and (2) on pial arteriolar diameter.

Methods: Halothane-anesthetized rats were fitted with instruments to measure CBF as determined by laser-Doppler flow (CBFldf) or to measure pial arteriolar diameter by preparing a cranial hollow deepened until a translucent plate of skull remained, thereby maintaining the integrity of the cranial vault. In both groups, 20 micro gram/kg dexmedetomidine was infused intravenously. Thirty minutes later, the mean arterial pressure was restored to control values with an infusion of phenylephrine (0.5 to 5 micro gram/kg/min).

Results: Administration of dexmedetomidine was associated with decreases in end-tidal and arterial carbon dioxide. The CBFldf and pial arteriolar diameter were measured during normocapnia (controlled carbon dioxide) and during dexmedetomidine-induced hypocapnia. Intravenous administration of dexmedetomidine significantly decreased systemic arterial pressure concurrent with a decrease in CBFldf (22% in normocapnic animals, 36% in hypocapnic animals). Restoration of mean arterial pressure increased CBFldf in normocapnic but not in hypocapnic animals. Similarly, dexmedetomidine significantly reduced pial vessel diameter in both normocapnic (9%) and hypocapnic animals (17%). However, vessel diameters remained decreased in the normocapnic and hypocapnic animals after the mean arterial pressure was restored.