COMPUTER CONTROLLED INFUSION OF PROPOFOL

A computer controlled infusion pump was used to deliver propofolto two groups of eight patients undergoing body surface surgery.The patients were premedicated with morphine sulphate i.m. andanaesthesia was supplemented with 66% nitrous oxide in oxygen.Patients in group 1 breathed spontaneously, whereas patientsin group 2 underwent artificial ventilation to a normal Pa_co2.The computer program was designed to achieve and maintain ablood concentration of propofol 3 µg ml^–1 as rapidlyas possible, basing calculations on a three-compartment pharmacokineticmodel. Mean blood propofol concentrations were found to be closeto the predicted target from 10 to 120 min in group 1, but were5–20% higher from 20 min in group 2. ^*Department of Anaesthetics, Royal Devon and Exeter Hospital(Wonford), Barrack Road, Exeter, Devon. Department of Anaesthetics, Weston General Hospital, WestonGeneral Hospital, Weston Super Mare, Devon.     

STUDY OF THE POSSIBLE INTERACTION BETWEEN FENTANYL AND PROPOFOL USING A COMPUTER-CONTROLLED INFUSION OF PROPOFOL

A computer-controlled infusion of propofol designed to achievea target blood concentration of propofol 3 µg ml^–1was used to investigate the possibility of an interaction betweenpropofol and fentanyl in 32 patients undergoing body surfacesurgery. In 16 patients who were not receiving a neuromuscularblocker during maintenance anaesthesia with 67% nitrous oxide,there were no significant differences in blood concentrationsof propofol between eight patients who received fentanyl 5 µgkg^–1 before induction of anaesthesia, and eight patientswho did not. In a further 16 patients who received vecuroniumduring maintenance anaesthesia with 67% nitrous oxide, therewere no significant differences in blood propofol concentrationsbetween eight patients who received fentanyl 5 µg kg^–1before induction of anaesthesia, and eight patients who didnot. Fentanyl administered i.v. immediately before a computer-controlledinfusion of propofol resulted in more satisfactory anaestheticconditions than when fentanyl was not used, but did not significantlyprolong the recovery time.     

WHY DO ANAESTHETISTS NEED CODES?

With the increasing availability of information technology inhospitals and the introduction of medical audit and resourcemanagement, there is a proliferation of anaesthetic data collectionsystems. The amount of data recorded varies from a completeanaesthetic record to a small subset of it. Most systems holddata in coded form for reasons of accuracy and compactness.Unfortunately, all the coding systems are different, makingcomparisons between different centres difficult. We proposethat there is a need to develop a standard national system forcoding anaesthetic terms (Br. J. Anaesth. 1993; 71: 602–606)     

Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction

In spite of intensive therapy, an otherwise fit 34-year-old man died following the hyperpyrexial reaction to an interaction between tranylcypromine and clomipramine. There was no evidence of drug overdose, but severe disseminated intravascular coagulation developed which proved fatal.