Combined spinal-epidural analgesia is effective in labour analgesia. Nitric oxide may play important roles in pregnancy and labour and is probably affected by labour pain. The aim of the present study was to explore the alteration in serum levels of nitric oxide metabolites, i.e. nitrate and nitrite, during labour with or without combined spinal-epidural analgesia.

Fifty pregnant women were recruited at the cervical dilatation of 3∼4 cm, 25 received combined spinal-epidural analgesia and 25 served as control. Twenty in the combined spinal-epidural analgesia group and 19 in the control group finished data collection and were included in the analysis. Blood samples were taken at study entry, full cervical dilation and 2 h after delivery. Total serum level of nitrite and nitrate was measured with enzymatic conversion and followed by Griess reaction. Visual analogue pain scores and mean blood pressure were monitored.

After analgesia, pain score and mean blood pressure were significantly lower in the combined spinal-epidural analgesia group than in the control group (P < 0.05). Serum levels of nitric oxide metabolites were not significantly different at study entry (P > 0.05) but significantly different at full cervical dilation and 2 h after delivery (P < 0.05 for both) between the control group and the combined spinal-epidural analgesia group. Serum levels of nitric oxide metabolites decreased significantly at full cervical dilation and 2 h after delivery compared with study entry in the control group (P < 0.05) and this decrease was almost abolished in the combined spinal-epidural analgesia group (P > 0.05).

Combined spinal-epidural analgesia provided effective analgesia and abolished the decrease in nitric oxide metabolites during active labour.

Failed intubation is an important cause of anaesthetic-related maternal mortality. The purpose of this study was to determine the ability to predict difficult visualization of the larynx from the following preoperative airway predictive indices, in isolation and combination: modified Mallampati test, the ratio of height to thyromental distance and the Upper-Lip-Bite test.

We collected data on 400 consecutive parturients scheduled for elective Caesarean delivery under general anaesthesia requiring endotracheal intubation and then assessed all three factors before surgery. An experienced anaesthesiologist, not apprised of the recorded preoperative airway assessment, performed the laryngoscopy and grading (as per Cormack and Lehane’s classification). Sensitivity, specificity and positive predictive value for each airway predictor in isolation and in combination were determined.

Difficult laryngoscopy (Grade 3 or 4) occurred in 35 patients (8.75%). The ratio of height to thyromental distance had a higher sensitivity, positive predictive value and fewer false negatives than the other variables tested. The ratio of height to thyromental distance of 21.24 provided the best cut-off point for predicting subsequent difficult laryngoscopy. The odds ratio (95% CI) of the ratio of height to thyromental distance, Mallampati class and the Upper-Lip-Bite test were 127.8 (44.8–364.5), 49.8 (20.3–121.8) and 6.6 (2.29–19.30), respectively.

The ratio of height to thyromental distance may prove a useful screening test for predicting difficult laryngoscopy in obstetric population.

Combined spinal epidural analgesia is effective for fast relief of severe labour pain but has been associated with worrisome decreases in fetal heart rate. Since the reasons for this phenomenon remain elusive, some anaesthesiologists may abstain from using this technique. We postulated that factors unrelated to the neuraxial technique could play a role in the decrease in fetal heart rate. To our knowledge, no prospective study has previously looked into this possibility.

We collected prospective data on 223 consecutive patients who received combined spinal epidural analgesia (123) or epidural analgesia (100). Maternal blood pressure, analogue pain scores, exogenous infusion of oxytocin, cervical dilatation, maternal age, parity and ethnicity were collected and correlated with the occurrence of decreases in fetal heart rate post combined spinal epidural.

Univariate analysis showed a correlation between the incidence of fetal bradycardia and higher maternal pain scores, older maternal age, and combined spinal epidural analgesia. Multivariate analysis revealed that only pain scores and maternal age were independent predictors of fetal bradycardia post neuraxial blockade.

Maternal pain scores and older maternal age are factors unrelated to the neuraxial technique that are independent predictors of fetal bradycardia after neuraxial analgesia for labour.

To investigate whether preemptive administered lornoxicam changes perioperative platelet function during thoracic surgery.

A total of 20 patients scheduled for elective thoracic surgery were randomly assigned to receive either lornoxicam (16 mg, i.v.; n = 10) or placebo (n = 10) preoperatively. All patients underwent treatment of solitary lung metastasis and denied any antiplatelet medication within the past 2 weeks. Blood samples were drawn via an arterial catheter directly into silicone-coated Vacutainer tubes containing 0.5 mL of 0.129 M buffered sodium citrate 3.8% before, 15 min, 4 h and 8 h after the study medication was administered. Platelet aggregation curves were obtained by whole blood electrical impedance aggregometry (Chrono Log®).

Platelet aggregation was significantly reduced 15 min, 4 h and 8 h after lornoxicam administration compared to placebo (P < 0.05) for collagen, adenosine diphosphate and arachidonic acid as trigger substances. Adenosine diphosphate-induced platelet aggregation decreased by 85% 15 min after lornoxicam administration, and remained impaired for 8 h.

Platelet aggregation assays are impaired for at least 8 h after lornoxicam application. Therefore perioperative analgesia by use of lornoxicam should be carefully administered under consideration of subsequent platelet dysfunction.

Lornoxicam is a novel non-steroidal anti-inflammatory drug with marked analgesic property. It has been shown to have analgesic potency similar to morphine and meperidine. Laryngoscopy and tracheal intubation provoke major haemodynamic responses. Minimizing perioperative adverse events in elderly patients is of utmost importance. The aim of this study was to demonstrate the effect of preoperative administration of Lornoxicam on haemodynamic changes during laryngoscopy and tracheal intubation in the elderly.

Fifty patients aged between 65 and 75 yr were randomly recruited to this randomized, double-blind, placebo-controlled study. They were divided into two groups to receive either Lornoxicam 8 mg or placebo half an hour before surgery. Systolic and diastolic blood pressure, mean arterial pressure, and heart rate were recorded before and after administration of the intravenous anaesthetic, also at 1, 3, 5 and 10 min after tracheal intubation.

In the control group, significant increases in the haemodynamic parameters were observed during the first 10 min following tracheal intubation (P < 0.05).

Preoperative administration of Lornoxicam attenuates the haemodynamic response to laryngoscopy and tracheal intubation in the elderly.

Diphenhydramine has local anaesthetic and antimicrobial activity and may be used to prevent intravenous propofol injection pain. We studied the effect of adding diphenhydramine to propofol emulsions for preventing bacterial growth.

Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans cultures were inoculated into the following solutions: 1% propofol, 0.05% diphenhydramine + 1% propofol, 0.1% diphenhydramine + 1% propofol, 0.2% diphenhydramine + 1% propofol, 0.3% diphenhydramine + 1% propofol, 1% diphenhydramine and 0.1% lidocaine + 1% propofol. A 100-μL of inoculum suspension adjusted for each of the micro-organisms was added separately to each tube and left at 20°C. A 10-μL aliquot of each mixture was inoculated onto blood agar medium at 5 and 24 h. These plates were incubated at 35°C for 24 h. Each plated medium was read, and the number of colony-forming units were counted and recorded (n = 2). Analysis of variance (ANOVA) with a post hoc Tukey HSD test and paired t-tests were used for data analysis. P < 0.05 was considered as significant.

Diphenhydramine inhibited bacterial growth in propofol solutions in a dose-dependent manner. It was more effective than 0.1% lidocaine at similar concentrations in preventing bacterial growth for all organisms.

Diphenhydramine had a significant inhibitory effect on bacterial growth in propofol.

The impact of anaesthesia using target-controlled infusion with propofol on intraoperative stability, recovery and cost compared to manually controlled infusion has been evaluated with inconsistent results. We studied a new device that allows more individual titration of propofol target-controlled infusion by using the effect-site concentration at the loss of eyelash reflex to predict the maintenance infusion rate (FM-TCI).

Fifty-six patients undergoing major abdominal surgery lasting >2 h were randomly assigned to receive either FM-TCI (n = 28) or MCI-controlled (n = 28) anaesthesia. Both groups were Bispectral Index-monitored and thoracic epidural analgesia was established. Anaesthetic stability, incidence of haemodynamic abnormalities, time to extubation, propofol consumption and patient satisfaction were assessed.

In the FM-TCI group, a significantly improved anaesthetic stability was achieved (0.43 ± 0.44 vs. 1.31 ± 0.78 adjustments of propofol infusion per patient per hour, P = 0.003) and time to extubation was significantly shorter (9.6 ± 2.1 vs. 15.7 ± 9.6 min P = 0.011). With FM-TCI, propofol consumption was significantly lower. Haemodynamic stability and patient satisfaction did not differ between the groups.

FM-TCI helps to provide more stable anaesthesia conditions requiring less-frequent adjustments of the propofol infusion compared to manually controlled infusion in patients undergoing major abdominal surgery.

The aim of this study was to compare waste gas concentrations during xenon or nitrous oxide anaesthesia.

A total of 64 patients were included in this study. Gas concentrations were measured with a mass spectrometer during anaesthesia. The probes were taken beside the patient’s head and thorax and at a height of 180 cm above and at the floor level.

In both groups, waste gas concentrations peak after intubation and extubation. Waste gas levels during xenon anaesthesia are low compared with nitrous oxide.

The low waste gas levels of xenon seem to be beneficial compared to nitrous oxide.

Sevoflurane has been shown to distinctly reduce bronchial mucus transport velocity, an essential determinant of mucociliary clearance and pulmonary complications. However, sevoflurane is regarded as one of the least irritant volatile anaesthetics, especially when compared with desflurane. Hence, the aim of this double-blind, randomized, controlled trial was to assess differences in bronchial mucus transport velocity between sevoflurane and desflurane.

Twenty patients listed for general surgery were randomized to receive either maintenance of anaesthesia with desflurane and fentanyl, or sevoflurane and fentanyl. Thirty minutes after tracheal intubation, bronchial mucus transport velocity was assessed by fibreoptic observation of the movement of methylene blue dye applied to the dorsal surface of the right main bronchus.

Both agents distinctly reduced bronchial mucus transport velocity when compared with previous studies, but the degree of impairment did not significantly differ between the investigated groups (median [25%/75% percentile]): desflurane 1.5 [0.5/4.2] vs. sevoflurane 1.3 [0.3/2.9] mm min−1, P = 0.343).

Desflurane is commonly regarded as more irritant to the airway, but as far as bronchial mucus transport velocity is concerned, the choice between sevoflurane and desflurane does not seem to matter.

The purpose of this study was to investigate the acceptability and therapeutic efficacy of a preoperative single administration of long-acting 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist in an orally disintegrating tablet formulation, ramosetron, in breast cancer patients.

Two hundred and forty women, ASA I-II, aged 24–60 yr, undergoing elective breast cancer surgery, were randomized. A standardized anaesthetic technique was used. Patients were assigned to receive one of three treatment regimens (n = 80 in each group): no prophylactic antiemetics (Group A), single prophylactic intravenous injection of ramosetron 0.1 mg at the completion of surgery (Group B) or preoperatively oral administration of 0.1 mg of ramosetron (Group C). Episodes of nausea and vomiting, the use of rescue antiemetic treatment, degree of pain, adverse events and level of satisfaction were recorded.

The overall incidence of nausea and vomiting during the first 24 h after the recovery in Groups B (27.8%) and C (25%) was decreased significantly compared with Group A (75.3%). The frequency of the use of rescue antiemetics was significantly lower in Group C (5.0%) compared with Groups A (53.2%) and B (15.2%). The patients in Group C were more satisfied with control of postoperative nausea and vomiting than others.

Preoperative oral administration of ramosetron at a dose of 0.1 mg is an acceptable and effective way of reducing the incidence of postoperative nausea and vomiting in breast cancer patients.