Tracheal and arterial CO2 partial pressures were measured simultaneously in 27 laryngectomized patients both while they were awake and during high-frequency jet ventilation. Tracheal gas was sampled during brief interruptions of high-frequency jet ventilation. Agreement between tracheal and arterial CO2 partial pressures was assessed using the Bland–Altman method. The tracheal–arterial CO2 partial pressures gradient during spontaneous breathing was significantly lower (P<0.0002) than during high-frequency jet ventilation. During spontaneous ventilation, the bias was −0.77 kPa (95% CI= −0.99 to −0.55 kPa), and the upper and lower limits of agreement were 0.29 kPa (95% CI= −0.11 to −0.7 kPa) and −1.83 kPa (95% CI= −2.24 to −1.43 kPa). During high-frequency jet ventilation, the bias was −1.61 kPa (95% CI= −1.76 to −1.46 kPa), and the limits of agreement were −0.48 kPa (95% CI= −0.75 to −0.21 kPa) and −2.74 kPa (95% CI= −3.01 to −2.47 kPa). Despite the poor agreement between tracheal CO2 partial pressure and arterial CO2 partial pressure, it is sufficient to allow for adjustment of ventilator settings during jet ventilation.

A postal survey was carried out on every 71st person aged between 18 and 80 in the population registers in County Regierungsbezirk Karlsruhe in the State of Baden-Würtemberg. It asked 2127 persons whether they had, in the previous 6 months, experienced any form of unduly prolonged pain (as distinct from brief intercurrent self-limiting episodes related to injury inflammation etc.) and, if so, to specify its location, duration, severity and persistence. It also sought information on the resulting calls on healthcare professionals and the degree of satisfaction with treat-ments received. The age and gender distributions of the sample selected for survey matched those in the population from which it was drawn. Of the 1420 respondents, only 1304 declared their age and gender – a condition for inclusion in the analysis. Of these, 610 reported some form of unduly prolonged pain, which had lasted more than a year in 530. For all pain lasting longer than a year, the estimated prevalence of mild pain was 11%, severe 25% and intolerable 3.5%: the corresponding estimates for persistent as opposed to episodic pain were 2% for mild, 10% for severe and 1% for intolerable. Pain was present in more than one anatomical location in most of those who reported it. Musculoskeletal pain was overwhelmingly the most common.Increasing age, obesityandbeing femalepre-disposed to the reporting of pain, with women being more liable to report headache and pain in the neck and shoulder.One hundred and thirty-six pain reporters either gave no information on consultation or sought no help from healthcare professionals: a third of the remainder consulted more than one professional, with general practitioners and specialists in physical medicine (niedergelassener Orthopäde) being the most common. A wide variety of treatments were used, with oral medications, massage, exercises, mud pack and heat treatment being the most popular; two-thirds of sufferers used more than one type of treatment. The most popular types of treatment tended also to be the most successful, except for oral medication (which was also the most heterogeneous). Multiple logistic regression analyses identified consistent associations between duration and severity of pain, the number of sites where it was reported, the numbers of healthcare professionals consulted and the number of treatments tried, and the same groupings of features were associated with decreased likelihood of overall satisfaction with treatment received.

Major knee surgery is associated with moderate or severe post-operative pain. Intrathecal morphine and continuous femoral 3-in-1 block were compared prospectively in 40 patients for pain after major knee surgery under spinal anaesthesia, with 4 mL isobaric 0.5% bupivacaine. In a random order, 20 patients received preservative free morphine 0.3 mg mixed with spinal bupivacaine. In 20 patients, following spinal anaesthesia with only bupivacaine, femoral 3-in-1 block was performed post-operatively with 0.5% bupivacaine 2 mg kg−1. The block was continued via a catheter with 0.25% bupivacaine 0.1 mL h−1 kg−1 until the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. Three patients in the morphine group and one patient in the femoral group did not need any additional oxycodone. In the morphine group on average 2.8 (range 0–7) and in the femoral group 3.2 (0–5) additional doses of oxycodone were needed during the 24 h observation period. The mean pain scores were significantly lower in the morphine group at 9 and 12 h into the 24-h trial. Itching was seen only in the morphine group (40% of the patients). Other side effects were similar in the two groups. All patients were satisfied with their pain therapy. Both intrathecal morphine and femoral 3-in-1 block alone were insufficient for the treatment of severe pain after major knee surgery.

The physical compatibility of thiopentone and propofol mixtures was investigated. The investigations used were macroscopic and microscopic observations, zeta potential and oil droplet size measurements. There was no evidence of instability in the mixtures. The thiopentone–propofol mixture has the potential advantage of reducing the pain on injection, provides synergistic interaction, does not prolong recovery when used for induction of anaesthesia, may reduce the incidence of convulsions and is cost-effective.

Recovery of neuromuscular blockade after vecuronium 0.2 mg kg−1 was measured by post-tetanic burst count (PTBC) and train-of-four (TOF) in 120 adult patients anaesthetized by one of four techniques: neuroleptanaesthesia or one minimum alveolar concentration of isoflurane, enflurane, or sevoflurane. Onset of recovery was taken when there was reflex movement in response to carinal stimulation. The time course of recovery measured by burst count was similar for all four types of anaesthesia. Recovery of each of the twitches of the TOF was significantly shorter under neuroleptanaesthesia than under isoflurane, enflurane, or sevoflurane anaesthesia [times to return of T1 were 41.4±5.4, 51.5±10.6, 52.2±10.0, or 55.3±11.2 min (mean±SD). P<0.05]. The burst count at the onset of reflex movement was less under neuroleptanaesthesia than under isoflurane, enflurane, or sevoflurane anaesthesia (16.3±4.8, 26.7±6.7, 27.7±6.8, 28.0±8.4, P<0.05). The ratio of first twitch to control twitch at the onset of reflex movement was the same for all four types of anaesthesia.

Local and systemic immune and haemostatic responses were studied in 10 patients, aged 57–78 years, undergoing elective hip arthroplasty. Cytokines, soluble cytokine receptors, interleukin-1 receptor antagonist, soluble adhesion molecules, antithrombin, fibrin, soluble and fibrin d-dimer were analysed in wound drainage blood and in blood taken from the systemic circulation for up to 24 h post-operatively. Wound drainage blood concentrations of cytokines, interleukin-1 receptor antagonist and soluble cytokine receptors were increased compared with those in the systemic circulation except for the soluble interleukin-6 receptor. In wound drainage blood, soluble tumour necrosis factor receptors (P<0.05), interleukin-1 receptor antagonist (P<0.05) and interleukin-6 (P<0.05–<0.01) increased during the study period. In blood from the systemic circulation interleukin-6 increased (P<0.05) while the soluble interleukin-6 receptor decreased (P<0.05) compared with pre-operative values. Concentrations of soluble adhesion molecules did not change. Wound drainage blood showed marked hypercoagulation. After hip arthroplasty pro-inflammatory cytokines and their inhibitors were mainly confined to the local trauma site. A predominance for inhibitors was noted.

One hundred and three patients ASA grades I–II, 16–80 years of age scheduled for arthroscopic meniscectomy were prospectively studied, and randomly allocated to one of four groups: group 1 (n=25): 0.25% bupivacaine (50 mg) intra-articular (IA), group 2 (n=27): 1 mg of 0.1% preservative free morphine chloride in saline, group 3 (n=26): 1 mg of 0.1% preservative free morphine chloride in 0.25% bupivacaine and group 4 (n=25): normal saline (0.9%). The volume given was always 20 mL. Ketorolac [Toradol®, 30 mg intramuscularly (i.m.)] was used as rescue medication; analgesia was assessed using a visual analogue scale (VAS), a verbal rating scale (VRS), supplemental analgesic consumption post-operatively (SAC) and the presence of side effects. Verbal rating scale and visual analogue scale scores showed better pain control in group 1, 20 min after surgery, and in groups 1 and 2 at 4 h and 10 h as well as in the global VAS. In multi-factorial analysis no significant differences among groups or side effects was found. pH analysis of the substances used showed no alterations in the basal pH range. The analgesic efficacy of 20 mL of bupivacaine 0.25% is similar to that of 1 mg of morphine in 20 mL of saline 0.9%. The morphine–bupivacaine mixture was no more efficacious than bupivacaine or morphine alone.

A telephone audit was carried out on patients 24 hours after day case surgery. An initial audit shortly after the day case opened indicated pain scores and nausea that were considered unacceptable. Some 8.6% of patients called their family doctor (GP) to visit their home in the post-operative period. Pre-operative Piroxicam 20 mg was then initiated (in most patients) to reduce the pain scores, which it did. Only one patient in 111 (0.9%) called their GP out, but nausea scores remained unchanged. Methods to reduce this index are suggested.

The objective of this prospective study was to determine the nocturnal/diurnal distribution of peri-operative cardiac dysrhythmias in patients with coronary artery disease undergoing major vascular surgery. Eight patients with significant coronary artery disease undergoing major vascular surgery were studied. Continuous Holter monitoring was performed on each patient from approximately 1 h pre-operatively until 2–5 days post-operatively. Frequencies of isolated supraventricular and ventricular premature beats, and runs of supraventricular and ventricular premature beats were calculated for 6-h periods (00.00–06.00; 06.00–12.00; 12.00–18.00; 18.00–24.00 hours). Supraventricular tachycardia occurred significantly more frequently between 00.00 and 06.00 hours than during the other 6-h periods studied in the post-operative period following major vascular surgery.

The purpose of this study was to identify whether the central extracellular fluid volume status following and pypo- hypervolaemia can be measured by the initial distribution volume of glucose or by the extravascular lung water. These two estimates were compared with the initial distribution volume of sucrose which has been used as an indicator for the measurement of the extracellular fluid volume. The above three estimates were determined by the administration of glucose, chilled saline and sucrose solutions, before and after haemorrhage (30 mL kg−1), and subsequent fluid load (lactated Ringer's solution 90 mL kg−1). The distribution volumes of glucose and sucrose decreased after haemorrhage and increased after fluid load compared with normovolaemic values, and a linear correlation was obtained between these two distribution volumes (r=0.93, P<0.001, n=36). How ever, the extravascular lung water remained statistically unchanged throughout the procedure, despite a weak linear correlation with the sucrose distribution volume ( r=0.38, n=33, P<0.05). These results indicate that the initial distribution volume of glucose is more useful as an indicator of the central extracellular fluid volume status than the extravascular lung water.

Prolonged nerve conduction blockade has been proposed to result from the summed effects of charged and neutral local anaesthetics. Thirty-seven patients were randomly allocated to receive intravenous patient-controlled analgesia alone or combined with intercostal blockade (T7–T11) with a mixture of 0.45% bupivacaine and 0.6% phenol for post-cholecystectomy analgesia. Adequacy of pain relief was measured by patient scores on a 10-cm visual analogue scale and by dose–demand ratio, amounts of loading dose and total consumption of morphine and also the duration of patient-controlled analgesia in each group. No differences were found between groups in post-operative scores, dose–demand ratios and loading doses of morphine. However, in the combined treatment group, a significantly lower total consumption of morphine (P<0.05), associated with a shorter duration of patient-controlled analgesia (P<0.02) and a decreased mean number of unsuccessful demands (P<0.001) were recorded. Intercostal blockade with bupivacaine–phenol supplements intravenous patient-controlled analgesia for post-cholecystectomy pain relief.

The effectiveness of a balanced analgesia with buprenorphine ketoprofen-propacetamol for pain control during extracorporeal shock wave lithotripsy (ESWL) was evaluated in order to reduce the requirements for general anaesthesia. Two hundred and ninety-one consecutive patients were included in a randomized, placebo-controlled, double-blind study. Patients in each group received midazolam 5 mg pre-operatively as premedication. The subjects then received either placebo (group 1), buprenorphine 0.3 mg (group 2) or the combination buprenorphine 0.3 mg plus ketoprofen 100 mg and propacetamol 2 g (group 3) intravenously (i.v.) at a constant rate. The treatment was started 45 min prior to ESWL. Pain was assessed using a three-point verbal scale: (0)no pain; (1) moderate pain; and (2) intense pain needing general anaesthesia. The patients assessed their pain intensity on a 0–100 mm visual analogue scale. Only 69% of group 1 patients received ESWL with midazolam premedication. Buprenorphine provided good analgesia in 87% of group 2 patients, while the combination buprenorphine-ketoprofen-propacetamol was effective in 99% of group 3 patients (P<0.05). The incidence of nausea and vomiting was similar in the buprenorphine groups. No respiratory depression was reported. In conclusion, the buprenorphine-ketoprofen-propacetamol combination provided effective analgesia, allowing ESWL to be performed without the need for general anaesthesia.