ERRATUM

IN the last number of the Journal (July 1937) Dr. Stanley Rowbothamwas described as "Anæsthetist, King's College Hospital,"etc. This should have read "Anæsthetist, Charing CrossHospital," etc., and we apologise for the mistake.     

Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty

Background. Peripheral neural blockade appears to provide effectiveanalgesia with potentially less morbidity than central neuraxialtechniques. We compared the relative benefits of combined femoral(3-in-1) and sciatic nerve block with epidural blockade forpostoperative knee arthroplasty analgesia. Methods. Sixty patients, ASA I–III, undergoing unilateralknee replacement were prospectively randomized to receive eithera lumbar epidural infusion or combined single-shot femoral (3-in-1)and sciatic blocks (combined blocks). All patients receivedstandard general anaesthesia. Visual analogue pain scores andrescue opioid requirements were recorded at four time pointspostoperatively. Patient satisfaction, morbidity, block insertiontime, perioperative blood loss and rehabilitation indices werealso assessed. Results. In both groups, pain on movement was well controlledat discharge from recovery and 6 h postoperatively but increasedat 24 and 48 h. Median (95% CI) analogue scale scores were 0(0–0), 15 (0–30), 55 (38–75) and 54 (30–67)mm for epidural block and 0.5 (0–22), 21.5 (10–28),40 (20–50) and 34.5 (21–55) mm for combined block.VAS pain scores with the combined blocks were significantlylower at 24 h (P=0.004). Total morphine usage was low in bothgroups: median epidural group 17 mg (8–32) versus combinedblocks 13 mg (7.8–27.5). Patient satisfaction was highin both groups with median (95% CI) scores of 100 (85–100),83 (70–100) and 82 (57–90) mm for epidural and 90(73–100), 100 (77–100) and 97 (80–100) mmfor combined blocks (not significant). Perioperative blood lossand rehabilitation indices were also similar. Conclusions. Combined femoral (3-in-1) and sciatic blocks offera practical alternative to epidural analgesia for unilateralknee replacements.      

DOUBLE-BLIND, MULTIPLE-DOSE COMPARISON OF BUPRENORPHINE AND MORPHINE IN POSTOPERATIVE PAIN OF CHILDREN

In a randomized double-blind study of 57 children (aged 6 months–6yr), pain following lateral thoracotomy was relieved with repeatedi.v. doses of morphine 100 or 50 µg kg^–1, or buprenorphine3.0 or 1.5 µg kg^–1. The same drug and dosage werecontinued and cardio-ventilatory indices, pain intensity andsedation measured for an observation period of 24 h. The sumsof the pain intensity differences were equal in all groups.The mean doses for the complete initial analgesia were 230 and180 µg kg^–1 with the larger and the smaller bolusdoses of morphine and 5.8 and 3.7 µg kg^–1 with buprenorphine,respectively. The mean duration of action of buprenorphine wasslightly but not significantly longer than that of morphine.The total consumption of both morphine and buprenorphine wasless when the smaller bolus doses were used. Two patients developeda degree of ventilatory depression following repeated dosesof buprenorphine. Buprenorphine was equal to morphine as a postoperativeanalgesics.     

ACCURACY OF 94 ANAESTHETIC AGENT VAPORIZERS IN CLINICAL USE

Using the Brüel & Kjæ Anaesthetic Gas Monitortype 1304, we have monitored the output of 94 anaesthetic agentvaporizers (Fluotec 3: 58, Enfluratec 3: 24, Isotec 3. 12),in seven departments of anaesthesia, at different dial settingsand flow rates. The range of output, for one type of vaporizerand dial setting (flow: 6 litre min^–1 was largest withthe Fluotec 3 (0.85–1.55% when dial set to 1%) and smallestwith the Isotec 3 (0.85–1.15% when dial set to 1 %). Indetermining the number of vaporizers with unacceptable inaccuracy,we applied acceptance limits of ± 15% relative on eachvaporizer and each dial setting. Using a flow of oxygen 6 litremin^–1 17% of Fluotec 3, 8% of Isotec 3 and 71 % of Enfluratec3 vaporizers had outputs outside those limits. Even when somespecific conditions (vaporizers giving output beyond the limitsat any two or more dial settings; output beyond the limits inthe clinically relevant range (0.5–2%)) were added, asubstantial number of vaporizers did not perform within thelimits. We found a significantly greater accuracy of the vaporizersafter 3-monthly calibration checks (P < 0.05) compared withvaporizers undergoing service and calibration only annually.Using a questionnaire, we found that fewer than 30% of the anaesthetistsusing the vaporizers would accept aberrance be yond ±10% relative of the dial setting. (Br. J. Anaesth. 1993; 71:453–457)      

BUPRENORPHINE DISPOSITION IN PATIENTS WITH RENAL IMPAIRMENT: SINGLE AND CONTINUOUS DOSING, WITH SPECIAL REFERENCE TO METABOLITES

The disposition of buprenorphine has been studied in two patientgroups to assess the influence of impaired renal function onthe metabolism of buprenorphine and two of its metabolites,buprenorphine-3-glucuronide (B3G) and norbuprenorphine (NorB).A single i.v. dose of 0.3 mg was given to 15 patients (ninewith dialysis-dependent renal failure) undergoing lower abdominalor peripheral body surface surgery. Blood was sampled up to24 h. Concentrations of buprenorphine, B3G and NorB were assayedby a differential radio-immunoassay technique. There were nodifferences in buprenorphine kinetics between anaesthetizedhealthy patients and those with renal impairment: mean eliminationhalf-lives 398 and 239 min; clearance 651 and 988 ml min^–1apparentvolume of distribution at steady state 313 and 201 litre, respectively.Both metabolites were undetectable following the single i.v.dose. In a second group of 20 patients (eight with renal impairment),buprenorphine was administered by continuous infusion for provisionof analgesia and control of ventilation in the ITU (median infusionrate 161 µg h^–1 (range 36–230 µg h^–1)for a median duration of 30 h (2–565 h). Buprenorphineclearance in patients with normal and impaired renal functionwas similar (934 and 1102 ml min^–1, respectively), aswere dose-corrected plasma concentrations of buprenorphine.In patients with renal failure, plasma concentrations of NorBwere increased by a median of four times, and B3G concentrationsby a median of 15 times.     

Hans-Lukas Teuber: A Tribute

Hans-Lukas Teuber (1916–1977) was one of the most influentialneuropsychologists of his generation. In the first part of hiscareer he headed the Psychophysiology Laboratory at the NewYork University - Bellevue Medical Center. There he and hisassociates played a major role in establishing human neuropsychologyas a rigorous experimental science closely linked to contemporaryneurophysiology and experimental psychology. In the second partof his career he founded the Department of Psychology at theMassachusetts Institute of Technology. This rapidly became aworld center of the neuro- and cognitive sciences and a modelfor the establishment of new neuroscience centers that broughttogether neuroanatomy, neurophysiology, neuropsychology, andcognitive psychology into an interacting community. Teuber‘s contributions extended far beyond the institutionshe founded and the many important experimental and theoreticalpapers he wrote. He was a consummate organizer, synthesizer,and sponsor of research on the brain, as well as the mentorof many of today’s leading brain researchers. This specialissue on object recognition and the temporal lobes is dedicatedto his memory.     

Treatment of cardiogenic shock with levosimendan in combination with beta-adrenergic antagonists

Levosimendan, a calcium sensitizer, was used in combinationwith ß-adrenergic antagonists in a man aged 56 yrwith cardiogenic shock, complicating acute myocardial infarction,who developed severe tachycardia after dobutamine administration.The patient's trachea was intubated, his lungs were ventilated,and he was started on dopamine 5 µg kg^–1 min^–1and dobutamine 5 µg kg^–1 min^–1, titrated toa mean arterial pressure 65 mm Hg. He progressively became tachycardiac(>120 beats min^–1) with a cardiac index (CI) of 1.4litre min^–1 m^–2 despite adequate preload. Levosimendan6 µg kg^–1 was administered intravenously over 10min followed by a continuous infusion of 0.2 µg kg^–1min^–1 for 24 h. Within 30 min, the patient's CI increasedto 2.2 litre min^–1 m^–2, but the heart rate (HR)also increased from 142 to 155 beats min^–1. Esmolol 1mg kg^–1 i.v. was administered with a consequent transientdecrease in HR to 110 beats min^–1 without adverse haemodynamiceffects; however, HR increased again shortly afterwards. Carvedilol3.125 mg orally twice a day was then administered, and the dosewas increased to 6.25 mg orally twice daily on the followingday. Subsequently, HR decreased over time and both catecholamineswere discontinued 14 h after starting levosimendan infusion.The trachea was extubated within 20 h and the patient was dischargedto the ward on day 4 after admission. In conclusion, levosimendanin combination with a ß-adrenergic antagonist mayhave beneficial effects in patients with cardiogenic shock whoexhibit tachycardia in response to inotropic agents.     

Renal transplantation after Covtinavius speciosissimus poisoning

During the years 1979–1993 22 individuals were intoxicatedin Sweden by the mushroom Cortinarius speciosissimus. Nine ofthem developed end-stage renal failure (ESRF), and we describefive who have received renal transplants. Three were transplantedafter 6–9 months on haemodialysis; the other two regainedsome renal function after 2–6 months on haemodialysis,but had to be restarted on dialysis 24–30 months laterand were eventually transplanted. Two patients had kidneys donatedby a father and a brother respectively, three had cadavericorgans. All five developed satisfactory renal function withcurrent glomerular filtration rate (GFR) 31–79 ml/min(mean 56.2) after 5–10 (mean 7.0) years. To our knowledge,renal transplantation after Cortinarius poisoning has not beenreported before.     

Spread of subarachnoid hyperbaric amethocaine in pregnant women

In order to examine how the gestational period influences thespread of spinal anaesthesia, we have measured the extent ofspinal block produced by hyperbaric amethocaine 8 mg in 90 women.The patients were allocated to one of five groups accordingto the gestational period: non-pregnant group (n = 17), firsttrimester group (6–12 weeks, n = 14), second trimestergroup (13–24 weeks, n = 26), third trimester group (25–36weeks, n = 15) and term group (37–41 weeks, n = 18). Maximumcephalad spread of analgesia was significantly higher in thesecond trimester (median T3 (range T9–C6)), third trimester(T3 (T4–C7)) and term groups (T2.5 (T4–C8)) thanin the non-pregnant (T4 (T8–T2)) and first trimester groups(T4 (T11–C7)). We found that not only term pregnancy butalso second and third trimester pregnancies enhanced the spreadof spinal anaesthesia, and that first trimester pregnancy didnot affect the spread of spinal anaesthesia.     

Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery

Background. Cataract surgery is commonly performed under localanaesthesia with midazolam sedation. Dexmedetomidine, a sedative-analgesic,is devoid of respiratory depressant effects, and its use incataract surgery has not been reported. This double-blind studycompared the use of dexmedetomidine and midazolam in patientsundergoing cataract surgery. Methods. Forty-four patients undergoing cataract surgery underperibulbar anaesthesia randomly received either i.v. dexmedetomidine1 µg kg^–1 over 10 min; followed by 0.1–0.7µg kg^–1 h^–1 i.v. infusion (Group D), or midazolam20 µg kg^–1 i.v.; followed by 0.5 mg i.v. bolusesas required (Group M). Sedation was titrated to a Ramsay sedationscore of 3. Mean arterial pressure (MAP), heart rate (HR), readinessfor recovery room discharge (time to Aldrete score of 10), andpatients' and surgeons' satisfaction (on a scale of 1–7)were determined. Results. MAP and HR were lower in Group D compared with GroupM [86 (SE 3) vs 102 (3) mm Hg and 65 (2) vs 72 (2) beats min^–1,respectively] (P<0.05). Group D patients had slightly highersatisfaction with sedation [median (IQR): 6 (6–7) vs 6(5–7), P<0.05], but delayed readiness for discharge[45 (36–54) vs 21 (10–32) min, P<0.01] comparedwith patients in Group M. Surgeons' satisfaction was comparablein both groups [5 (4–6) vs 5 (4–6)]. Conclusion. Compared with midazolam, dexmedetomidine does notappear to be suitable for sedation in patients undergoing cataractsurgery. While there was a slightly better subjective patientsatisfaction, it was accompanied by relative cardiovasculardepression and delayed recovery room discharge.     

Dietary Fish Oil Supplements Preserve Renal Function in Renal Transplant Recipients with Chronic Vascular Rejection

The effect of dietary fish oil supplements on renal failureand lipid abnormalities was studied in 14 adult renal transplantrecipients with chronic vascular rejection. The rate of declineof renal function (assessed by studying the slope of reciprocalplasma creatinine plots) slowed significantly during a 6-monthperiod on fish oil supplements compared with the preceding 6-monthcontrol period (slope 1/cr during supplementation –3.6x 10^–5 µmol/l per month compared with –13.5x 10^–5 before, the difference in slope being –9.8x 10^–5, 95% confidence interval (CI) –16.2 x 10^–5,–3.5 x 10^–5, P<0.05). Total plasma triglycerideconcentrations decreased during supplementation (mean change–1.15 mmol/l, 95% CI –1.84, –0.47, P<0.003),but there was no change in total plasma cholesterol concentrationor urinary protein excretion. Platelet function was studiedin nine patients. Platelet aggregation induced by adrenalineand collagen was reduced by fish oils (median change in percent aggregation), adrenaline 2 µmol/ –36% (95%CI –68%, –8%, P<0.05), collagen 1 mg/l, –13%(95% CI –44%, –2%, P<0.05). Platelet thromboxaneA₂ release in response to these agents was also significantlyreduced. These results demonstrate that fish oils preserve residualfunction in renal graft failure due to chronic vascular rejection.     

Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit

We have compared the effects of dexmedetomidine and propofolon endocrine, metabolic, inflammatory and cardiovascular responsesin patients in the intensive care unit (ICU) after major surgery.Twenty patients who were expected to require 8 h of post-operativesedation and ventilation were allocated randomly to receiveeither an infusion of dexmedetomidine 0.2–2.5 µg kg^–1 h^–1or propofol 1–3 mg kg^–1 h^–1.Arterial pressure, heart rate and sequential concentrationsof circulating cortisol, adrenocorticotrophic hormone (ACTH),growth hormone, prolactin, insulin, glucose and interleukin 6were measured. An ACTH stimulation test was performed in allpatients who received dexmedetomidine. Heart rate was significantlylower in the dexmedetomidine patients. There were no differencesin arterial pressure, cortisol, ACTH, prolactin and glucoseconcentrations between the two groups. A positive response tothe ACTH stimulation test varied depending on the diagnosticcriteria used. The insulin concentration was significantly lowerin the dexmedetomidine group at 2 h (P=0.021), althoughthis did not affect blood glucose concentrations. Growth hormoneconcentrations were significantly higher in dexmedetomidine-treatedpatients overall (P=0.036), but circulating concentrations remainedin the physiological range. Interleukin 6 decreased inthe dexmedetomidine group. We conclude that dexmedetomidineinfusion does not inhibit adrenal steroidogenesis when usedfor short-term sedation after surgery. Br J Anaesth 2001: 86: 650–6     

Different effects of calcitriol and parathyroidectomy on the PTH--calcium curve in dialysis patients with severe hyperparathyroidism

BACKGROUND: The PTH–calcium sigmoidal curve is shifted to the right,the slope of the curve is steeper, and the set point of calciumis increased in dialysis patients with secondary hyperparathyroidism,compared to patients with low-turnover bone disease. These findingscould be related to increased parathyroid cell mass and increasedsensitivity of parathyroid cells to serum calcium variationsin these patients. Calcitriol therapy has been documented toreduce PTH levels by shifting the curve to the left and downward.The effect of a surgical reduction of parathyroid gland masson the PTH-calcium curve has not yet been investigated. In thisstudy we compared the effects of calcitriol and subtotal parathyroidectomy(PTH) on the dynamics of PTH secretion in response to acutechanges of serum calcium in two groups of dialysis patientswith severe hyperparathyroidism. METHODS: Fourteen dialysis patients treated for 6 months with high-dosei.v. calcitriol (1–2 µg thrice weekly), and 10 dialysispatients who underwent subtotal PTx were studied. The PTH–calciumrelationship obtained by inducing hypo- and hypercalcaemia bymeans of low and high calcium dialysis was evaluated beforeand 2–6 months after treatment. RESULTS: Both calcitriol and subtotal PTx significantly decreased PTH(respectively from 797±595 to 380±244 and from1036±250 to 70±34 pg/ml), as well as maximal PTHresponse to hypocalcaemia (PTHmax), and maximal PTH suppressionduring hypercalcaemia (PTHmin). When the PTH–calcium curveswere constructed using PTHmax as 100% to factor for differencesin absolute PTH levels and to provide an assessment of individualparathyroid cell function, a shift of the sigmoidal curve tothe left and downward, and a significant decrease in the setpoint of ionized calcium (from 1.31±0.05 to 1.26±0.05and from 1.36±0.09 to 1.22±0.07 mmol/1) was documentedwith both treatments. However, the slope of the PTH–calciumcurve increased after subtotal PTx indicating that the sensitivityof the parathyroid cell to serum calcium changes increased withPTx, while on the contrary it decreased with calcitriol. CONCLUSIONS: PTH secretion decreases proportionally more with calcitriolthan with surgery for a given decrease in the functional massof parathyroid cells. The change in the PTH–ICa sigmoidalcurve induced by subtotal PTx is due to the removal of a largemass of parathyroid tissue with advanced hyperplasia.     

Role of proteinases in renal hypertrophy and matrix accumulation

Graded compensatory renal growth was induced either by unilateral(UNX) or 5/6 nephrectomy (5/6-NX). Over the experimental periodof 16 weeks, kidney weight increased by 59% in SHAM animals,while the remaining kidney in UNX rats more than doubled itsinitial weight. The hypertrophic response was most pronouncedin the remnant kidney after 5/6-NX with a four fold incrementin kidney weight. Morphologically glomerular volume increasedmoderately after UNX(+27%), while 5/6-NX was associated withmarked glomerular hypertrophy (+87%). Significant focal sclerosiswas found in 11% of glomeruli in the remaining kidney afterUNX. By contrast 83% of glomeruli were sclerosed in the remnantkidney after 5/6-NX. In parallel, there was a significant increasein the glomerular protein/DNA ratio (+23%) in 5/6-NX but notin UNX animals. These glomerular alterations were associatedwith lower glomerular cysteine and metalloproteinase activities(collagenase, –57%; gelatinase, –49%) in 5/6-NXrats, while UNX rats had normal glomerular proteinase activities.In terms of tubular proteinases, cathepsin activities were significantlylower in UNX rats (cath. L+B, –38%; cath. B, –37%;cath. H, –27%) and more so after 5/6-nephrectomy (cath.L+B, –72%; cath. B, –73%; cath. H, –73%),while metalloproteinase activities were only reduced in 5/6-NXrats (collagenase, –35%; gelatinase, –58%). Thesefindings demonstrate that kidney hypertrophy is associated withreductions in renal proteinase activities. After UNX, whichleads to tubular hypertrophy and mild glomerular sclerosis,only tubular cysteine proteinase activities were suppressed.In contrast, in the 5/6-NX model, which is associated with hypertrophicand sclerotic alterations both at the glomerular and tubularlevels, pronounced reductions in glomerular and tubular cysteineas well as metalloproteinase activities were observed.     

Is the Size of an Epidural Haematoma Related to Outcome?

Summary  Recently we treated 54 patients with acute epidural haematoma, diagnosed by early CT scan and operated on quickly, within 6 hours after trauma.  In 18 cases the volume of the haematoma, calculated by three different methods, was more than 150 cc, and GCS score was equal to or less than 8.  In all 18 patients, as well as in another 36, we obtained good results: all patients survived and 17 fully recovered (only one was left with moderate neurological disability).  Our experience leads us to the conclusion that even volumes of over 150 cc can be compatible not only with survival but also with very low morbidity, if rapid surgical treatment is performed.     

Predictive performance of computer-controlled infusion of remifentanil during propofol/remifentanil anaesthesia

Background. The predictive performance of the available pharmacokineticparameter sets for remifentanil, when used for target-controlledinfusion (TCI) during total i.v. anaesthesia, has not been determinedin a clinical setting. We studied the predictive performanceof five parameter sets of remifentanil when used for TCI ofremifentanil during propofol anaesthesia in surgical patients. Methods. Remifentanil concentration–time data that hadbeen collected during a previous pharmacodynamic interactionstudy in 30 female patients (ASA physical status I, aged 20–65 yr)who received a TCI of remifentanil and propofol during lowerabdominal surgery were used in this evaluation. The remifentanilconcentrations predicted by the five parameter sets were calculatedon the basis of the TCI device record of the infusion rate–timeprofile that had actually been administered to each individual.The individual and pooled bias [median performance error (MDPE)],inaccuracy [median absolute performance error (MDAPE)], divergenceand wobble of the remifentanil TCI device were determined fromthe pooled and intrasubject performance errors. Results. A total of 444 remifentanil blood samples were analysed.Blood propofol and remifentanil concentrations ranged from 0.5to 11 µg ml^–1 and 0.1 to 19.6 ng ml^–1respectively. Pooled MDPE and MDAPE of the remifentanil TCIdevice were –15 and 20% for the parameter set of Mintoand colleagues (Anesthesiology 1997; 86: 10–23), 1 and21%, –6 and 21%, and –6 and 19% for the three parametersets described by Egan and colleagues (Anesthesiology 1996;84: 821–33, Anesthesiology 1993; 79: 881–92, Anesthesiology1998; 89: 562–73), and –24 and 30% for the parameterset described by Drover and Lemmens (Anesthesiology 1998; 89:869–77). Conclusions. Remifentanil can be administered by TCI with acceptablebias and inaccuracy. The three pharmacokinetic parameter setsdescribed by Egan and colleagues resulted in the least biasand best accuracy. Br J Anaesth 2003; 90: 132–41     

Changes in Glomerular Cross-Sectional Area Induced by Platelet Activating Factor

Isolated glomeruli from normal rats were incubated with platelet-activatingfactor 10^–6 M at variable incubation times (8, 15, 30and 45 min) and with different concentrations (0 to 10^–6M) for 20 min. In addition, the platelet-activating factor effect(10^–6 or 10^–8 M, 20 min) was tested in the presenceof BN-52021 (10 or 50 µg/ml), verapamil (10^–5 M),acetylsalicylate of lysine (10^–3 M), and in a free-calciummedia with EGTA 2 mM. Glomerular microphotographs were takenbefore and 20 min after adding the substances, and glomerularcross-sectional area was measured using a computerised technique. Platelet-activating factor induced a significant time-dependentreduction in glomerular cross-sectional area, from a concentrationof 10^–8 M. BN-52021, verapamil, and the free-calcium mediainhibited platelet-activating factor-induced reduction of glomerularcross-sectional area, but acetylsalicylate of lysine did not.Platelet-activating factor-induced reduction in glomerular cross-sectionalarea seems to be dependent on the interaction of platelet-activatingfactor with a specific glomerular receptor, with a subsequentmodification of the intracellular concentration of calcium.Arachidonic acid metabolites from the cyclo-oxygenase pathwaydo not seem to be involved in these phenomena. Results suggest that platelet-activating factor could modulateglomerular filtration rate not only by inducing changes in systemicor intrarenal haemodynamics, but also by modifying the filtrationsurface, thus reducing the Kf.     

Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial

Background: Postoperative cognitive impairment after general anaesthesia,especially in the elderly, is a well-recognized problem. Xenon,known to be an N-methyl-D-aspartate antagonist, may be advantageous.In this study, the early cognitive function in the elderly aftergeneral anaesthesia with xenon was compared with that afterdesflurane. Methods: After approval by the local ethical committee and after obtainingwritten informed consent, patients were enrolled in this randomized,double-blinded, controlled study. Thirty-eight patients (65–75yr old, ASA status I–III) undergoing an elective surgerywith a planned duration of 60–180 min were allocated toeither the xenon (n = 18) or the desflurane (n = 20) anaesthesiagroup. The primary outcome was the cognitive Test for AttentionalPerformance (TAP) with its subtests Alertness, Divided Attention,and Working Memory. After baseline assessment 12–24 hbefore operation, patients were followed-up 6–12 and 66–72h after operation. Secondary outcomes were emergence times fromanaesthesia and the modified Aldrete score. Results: No difference was found between the groups in the TAP at 6–12and 66–72 h after operation. In the xenon group, emergencetime was significantly faster for the following parameters:time to open eyes (P = 0.001), to react on demand (P = 0.001),to extubation (P = 0.001), and for time and spatial orientation(P = 0.007). The modified Aldrete score was significantly higherafter 30, 45 and 60 min in the xenon group. Conclusions: There was no difference in the postoperative cognitive testingat 6–12 and 66–72 h. Xenon was associated in theelderly with a faster emergence from general anaesthesia thandesflurane.