Regional anaesthesia for repeat Caesarean section in a patient with phantom limb pain

The triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri-operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block     

Cardiac Dysrhythmias and Heart Rate Changes at Induction of Anaesthesia: A Comparison of Two Intravenous Anticholinergics

Glycopyrrolate, 0.2 mg, or atropine, 0.6 mg, was administered intravenously together with methohexitone for the induction of anaesthesia in unpremedicated patients. The use of atropine, compared with glycopyrrolate, was associated with a greater rise in heart rate, a greater number of patients whose heart rates doubled, and a higher incidence of dysrhythmias. Glycopyrrolate is recommended for use as an intravenous anticholinergic agent, particularly in patients with cardiovascular impairment.     

Total intravenous anaesthesia for laparoscopy

Two techniques of total intravenous anaesthesia for laparoscopy were compared in 80 patients. Group 1 received alfentanil, propofol and vecuronium, and Group 2 alfentanil, midazolam, ketamine and vecuronium. Haemodynamic stability after induction and the pressor response to tracheal intubation were significantly different. There was no significant difference in recovery times between the two groups and little difference in other postoperative sequelae.     

Hypoxaemia during outpatient dental anaesthesia

Eighty children, ASA grade 1, who had outpatient general anaesthesia for tooth extraction were studied. An inhalational induction was performed, with patients receiving halothane, nitrous oxide and either 33% or 50% oxygen. Oxygen saturation was measured throughout the procedure using the Ohmeda Biox 3700 pulse oximeter. No significant difference in the incidence of hypoxaemia was found between the two groups. There was no association between the grade of surgeon or anaesthetist and the incidence of hypoxaemia.     

Induction characteristics of propofol in children: comparison with thiopentone

The induction characteristics of propofol were studied and compared with thiopentone in children aged 3-14 years who received either no premedication or pethidine-atropine or trimeprazine. Anaesthesia was maintained with nitrous oxide in oxygen, and isoflurane. The induction doses of propofol and thiopentone were 2.9 mg/kg and 6.5-7.1 mg/kg respectively; premedication had no significant effect on the induction doses of either agent. Spontaneous movement and hypertonus occurred in about 20% of children with both agents. The use of propofol was associated with a high incidence of pain on injection (injections were mostly in veins on the dorsum of the hand), but this was reduced by mixing lignocaine with propofol. Cardiovascular effects were not clinically significant with either agent. Apnoea occurred in 35% of patients given propofol and in 50% of those given thiopentone. Children anaesthetised with propofol awoke significantly earlier after cessation of all anaesthesia. It is concluded that the use of propofol is safe in children and may have advantages where early recovery from anaesthesia is desirable, but offers no advantage over thiopentone for routine induction of anaesthesia.