The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

The effect of subhypnotic doses of propofol on intrathecal morphine-induced pruritus was studied in a prospective, randomly allocated, double-blind controlled trial. Fifty-eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative-free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. Pruritus was assessed using a five-point verbal rating scale at hourly intervals for 8 h. A second dose of their allocated treatment drug was administered at the first recording of significant pruritus. The pruritus score was reassessed after 5 min and the treatment was repeated if pruritus remained. There were no differences between the groups in the onset of pruritus or its successful treatment. No adverse side-effects were associated with this dose of propofol. There were no differences in the incidence of post-operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine-induced pruritus in women following Caesarean section.     

Acupuncture anaesthesia Observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital

Acupuncture anaesthesia, supplemented by small doses of pethidine, was evaluated in 20 patients who had surgery for removal of a thyroid adenoma. There were significant increases in mean arterial pressure and respiratory rate during surgery, but no significant change in heart rate. The mean dose of pethidine given during surgery was 45 mg (SD 8.9). Postoperative recovery was rapid and complication free. Acupuncture anaesthesia did not provide complete analgesia, but was safe and preferable to general anaesthesia where there was a shortage of facilities.     

针刺辅助麻醉在围手术期中的应用

针刺麻醉是一种减轻疼痛和调节病人生理功能紊乱的方法.具有止痛和镇静的作用.目前作为一种辅助麻醉的方法,用于术前镇静、术中辅助麻醉、术后镇痛、预防手术后恶心呕吐及治疗围手术期并发症.但对其在围手术期的应用仍存在许多矛盾的观点,对其效能及可能的机制仍需将来做进一步的研究.     

Postoperative nausea and vomiting in arthroscopic day-case surgery: a comparison between desflurane and isoflurane

We compared the postoperative effects, in particular nausea and vomiting, of two commonly used anaesthetic agents, isoflurane and desflurane, in patients undergoing day-case arthroscopic surgery. We found a significantly higher incidence of postoperative nausea and vomiting in those patients receiving desflurane. In our study, desflurane was associated with a higher incidence of peroperative respiratory complications, including airway irritability and coughing.     

Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia

Background. This study was designed to examine the analgesicand dose-related antiemetic efficacy of diphenhydramine–morphinemixture for intravenous patient-controlled analgesia (PCA). Methods. Healthy women, undergoing abdominal total hysterectomywere recruited to this double-blinded randomized placebo-controlledstudy. Patients were randomly allocated to one of three groups(n=40 each). In group 1, patients received saline at inductionand morphine 1 mg ml^–1 alone for postoperative PCA. Patientsin groups 2 and 3 received diphenhydramine 30 mg i.v. at inductionand were given a 1.2:1 or a 4.8:1 ratio, respectively, of diphenhydramine–morphinemixture for postoperative PCA. Results. A total of 112 patients completed the study. The incidenceof postoperative nausea (31.6% vs 67.6%, P<0.01) and vomiting(15.8% vs 40.5%, <0.05) was significantly lower in group3 than in group 1. Furthermore, the incidence of severe nauseawas significantly lower in group 3 than in group1 (2.6% vs 24.3%,P<0.05). The rescue antiemetic requirements were also significantlyless in group 3 than in group 1 (5.3% vs 24.3%, P<0.05).However, there was no significant difference between group 2and group 1 in any of the comparisons. Pain intensity, 24-hmorphine consumption and diphenhydramine-related side-effects,such as sedation or dry mouth, did not differ among the threegroups. Conclusion. An initial bolus of diphenhydramine 30 mg at anaestheticinduction followed by postoperative PCA with a 4.8:1, but not1.2:1, diphenhydramine–morphine mixture provides an effectiveantiemetic efficacy without morphine-sparing effects.     

Exaggerated epidural blockade resulting from unusual spread of bupivacaine in a patient with low back pain

A 75-year-old woman with chronic low back pain was given bupivacaine and methylprednisolone epidurally through a catheter in the L1-L2 interspace. An unusual spread of bupivacaine resulted in a block from the C4 to the L1 dermatome with no relief of back pain. Injection of a radiopaque dye and subsequent X rays showed a similar spread. The possible causes are discussed.     

Studies in postoperative sequelae. Nausea and vomiting—still a problem

We collected data on postoperative nausea and vomiting from 3850 patients aged 11–91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).     

Cardiovascular collapse following epidural anaesthesia for Caesarean section in a patient with aortic incompetence

A death following epidural anaesthesia for Caesarean section in a patient with aortic incompetence and pre-eclampsia is described. Possible hazards of epidural anaesthesia in aortic incompetence are described and it is suggested that reduction of total peripheral resistance is contraindicated in such patients.     

Comparison of laser acupuncture and metoclopramide in PONV prevention in children

BACKGROUND: Postoperative nausea and vomiting (PONV) are frequent side effects of general anesthesia in children. The aim of this study was to compare the effectiveness of laser acupuncture with metoclopramide in prevention of PONV in children after sevoflurane anesthesia. METHODS: A total of 120 children ASA I and II, scheduled for hernia repair, circumcision or orchidopexy were randomly assigned into three groups: group I, received laser acupuncture on P6 point and saline infusion; group II, metoclopramide 0.1 mg.kg(-1) i.v. and sham laser; group III had sham laser and saline infusion. Anesthesia was maintained with sevoflurane and N(2)O/O(2). Patients were monitored for any symptoms of retching and vomiting at 2, 6 and 24 h postoperatively. RESULTS: The incidence of vomiting was higher in the control group in the first 2 h postoperatively (P < 0.001), compared with the other groups. There was no statistically significant difference between acupuncture and metoclopramide groups in occurrence and timing of vomiting (P < 0.001). CONCLUSION: Laser acupuncture is equally effective as metoclopramide in preventing PONV in children.     

A ''postspinal headache'' associated with incidental intracranial pathology

A 28-year-old woman developed symptoms of raised intracranial pressure associated with an obstructive hydrocephalus following a spinal anaesthetic administered for a Kiellands rotation forceps delivery. A diagnosis of an unverified pineal body tumour was made after computerised axial tomography scanning and the symptoms were effectively treated by the insertion of a ventriculoperitoneal shunt. This unusual case demonstrates the importance of careful history taking and neurological examination where symptoms of postspinal headache persist.     

Paraesthesia with lumbar epidural catheters.

The epidural space was located in 32 obstetric patients using loss of resistance to air, while in a further 35 saline was used. The incidence of paraesthesia was 56% in the air group and 57% in the saline group. There was no significant difference between the groups in terms of other complications or in the quality of analgesia provided.     

Post-thoracotomy paraplegia coincident with epidural anaesthesia

We report a case of paraplegia in the immediate postoperative period following right bilobectomy for carcinoma of the lung. An epidural catheter had been inserted following induction of anaesthesia and an infusion of bupivacaine 0.15% was used for postoperative pain relief. Magnetic resonance imaging failed to reveal any spinal or epidural haematoma or spinal cord ischaemia. The patient developed respiratory failure on the third postoperative day and required assisted ventilation. He was weaned from the ventilator on day 15. Two days later he sustained a cardiac arrest and died. Post-mortem examination demonstrated spinal cord infarction and severely stenosed spinal arteries. The thoracotomy position and/or intra-operative hypotension might have compromised the blood flow to the spinal cord and although suspected as a possible cause, the use of epidural analgesia was not implicated.     

Spinal catheter anaesthesia for Caesarean section in a patient with spina bifida

A patient with grossly deformed vertebral anatomy, scheduled for elective Caesarean section, expressed her wish to stay fully awake during the procedure. Epidural anaesthesia was considered to be impracticable, while dural puncture appeared possible only at thoracic level. Spinal anaesthesia using a subarachnoid catheter placed at T7-8 was employed successfully.     

Posture and epidural catheter insertion. The relationship between skill, experience and maternal posture on the outcome of epidural catheter insertion

This study was undertaken to investigate the outcome of epidural catheter insertion in the sitting or lateral position in mothers during labour. An initial prospective randomised study period (144 patients) suggested that the sitting position offered some superiority over the lateral in terms of technical ease of insertion. It was concluded, by minimising the subjective aspects in a follow-up, prospective nonrandomised study period (152 patients), that the determining factor lies in the skill and experience of the anaesthetist. There was no significant difference in complication rates or maternal discomfort between the two positions in either study period.     

Cannulation of the epidural space

A group of 685 obstetric patients were randomly allocated to have their epidural block performed using either a 16-gauge or an 18-gauge Tuohy needle. Bleeding was noted from needle or catheter trauma in 18% of patients and it proved impossible to insert the catheter in 3%. The majority of mothers experienced little discomfort during the procedure but 2% found insertion to be very uncomfortable. There was no significant difference in the complication rate, ease of use, or patient discomfort between the 18- or 16-gauge needles. Epidural analgesia, although safe, is not without hazard. It may be difficult to perform and may, rarely, cause considerable discomfort.