Summary

Background and objective: To prevent neurological complications, low-flow antegrade cerebral perfusion (ACP) is used during repair of complex congenital heart defects. To overcome technical problems, continuous monitoring of cerebral blood flow and oxygenation is mandatory. The aim of the study was to evaluate the effect of different ACP flow rates on cerebral oxygen saturation obtained by near infrared spectroscopy.

Methods: Ten consecutive neonates undergoing Norwood stage I were included. In addition to near infrared spectroscopy (Invos 5100; Somanetics Corp., USA) on both hemispheres, mean arterial pressure and transcranial Doppler flow velocity were measured continuously and arterial and jugular venous oxygen saturation intermittently. Cerebral oxygen extraction ratio was calculated. Measurement points were obtained after starting bypass, during ACP with flow rates of 30, 20 and 10 mL kg−1 min−1 and immediately after ACP. ANOVA and Tukey–Kramer multiple comparison test were used for statistics.

Results: The near infrared spectroscopy signal could be obtained in all children at all measurement points, whereas transcranial Doppler failed in 1 neonate at a flow rate of 30 mL kg−1 min−1, in 3 neonates at 20 mL kg−1 min−1 and in 4 neonates at 10 mL kg−1 min−1. With the reduction of flow there was a significant decrease of cerebral oxygen saturation on both hemispheres (right: 78 ± 8 to 72 ± 9 and 66 ± 8, P < 0.001; left: 71 ± 7 to 65 ± 7 and 60 ± 7, P < 0.001), of jugular venous oxygen saturation (94 ± 6 to 89 ± 13 and 83 ± 15, P < 0.001) and a significant increase in oxygen extraction ratio (9.1 ± 8 to 14.8 ± 14 and 21 ± 16, P < 0.001) respectively, for 30, 20, 10 mL kg−1 min−1.

Conclusion: Near infrared spectroscopy reliably detects flow alterations during ACP with profound hypothermia.

Summary

Background and objective: It has been shown that racemic ketamine increases coronary blood flow and that this effect is at least in part due to a direct vasorelaxing effect of this substance. This study was designed to determine whether ketamine might stereoselectively relax isolated porcine coronary arteries.

Methods: Using the model of isolated vessels we studied the effects of S(+) ketamine, R(−) ketamine, and racemic ketamine (5–500 μg mL−1) on artery strips pre-contracted by either potassium chloride (KCl) or prostaglandin F2α (PGF2α). To elucidate possible mechanisms of action these experiments were repeated in the presence of one of the following compounds: Nω-nitro-l-arginine (l-NNA), indomethacin, glibenclamide, and tetraethylammonium (TEA) chloride, an inhibitor of the BKCa K+ channel.

Results: Both isoforms and racemic ketamine relaxed isolated coronary arteries in a concentration-dependent manner in concentrations beyond those used in clinical practice. S(+) ketamine exerted the strongest vasorelaxing effect, followed by racemic ketamine and R(−) ketamine. Pretreatment with l-NNA, indomethacin, or glibenclamide did not alter the vasodilating properties of ketamine, whereas TEA chloride significantly attenuated the vasorelaxing effects of all the three forms of ketamine.

Conclusions: Ketamine dilates coronary arteries in vitro when administered in high concentrations. There is a stereoselective difference with a stronger vasorelaxing effect of S(+) ketamine compared to racemic and R(−) ketamine. The impact of TEA chloride suggests that the activation of the BKCa channel may contribute to the vasodilating effect of ketamine.

Summary

Background and objectives: Sodium bicarbonate is the most physiological alkalinizing agent. The effect of a new bicarbonated Ringer's solution (BRS) containing Mg2+, on metabolic acidosis and serum magnesium abnormality were evaluated and compared with those of acetated Ringer's (ARS), lactated Ringer's (LRS) and Ringer's (RS) solutions in an experimental haemorrhagic shock model with dogs. Methods: Animals were randomly divided into six groups (n = 6 in each group), a sham-operated group, an operated group without infusion, and 4 operated groups with infusion (BRS, ARS, LRS and RS groups). Each RS was intravenously administered at 60 mL kg−1 h−1 for 1.5 h. Arterial blood gases, plasma electrolytes and cardiovascular parameters were analysed. Results: BRS significantly improved blood base excess values, which were decreased by blood-letting, faster and more markedly than did LRS and RS (BRS −6.3 ± 0.5 mEq L−1; LRS −9.2 ± 1.1 mEq L−1; RS −12.4 ± 1.0 mEq L−1 at the end of infusion). The alkalinizing effect of BRS tended to be better than that of ARS but not significantly so. The serum Mg2+ concentration was well-maintained by BRS as compared to other RS (BRS 1.5 ± 0.0 mg dL−1; ARS 1.2 ± 0.0 mg dL−1; LRS 1.1 ± 0.0 mg dL−1; RS 1.3 ± 0.1 mg dL−1, at the end of infusion). Conclusions: These results suggest that BRS is a suitable perioperative solution for metabolic acidosis and serum electrolyte balance among RS tested.

Summary

Background and objective: The effects of bicarbonated Ringer's solution were evaluated and compared with those of acetated Ringer's, lactated Ringer's and Ringer's solutions in partially hepatectomized rabbits. Method: Animals were randomly divided into six groups (n = 6 in each group): a sham-operated group, an operated group without infusion, and four operated groups with infusions of each of the four Ringer's solutions. Each Ringer's solution was intravenously administered at 40 mL kg−1 h−1 for 1.5 h. Arterial blood gases, plasma magnesium concentrations and cardiovascular parameters were analysed. Results: The partial hepatectomy-induced decrement of base excess was inhibited by bicarbonated Ringer's solution more remarkably than by either lactated or plain solutions (P < 0.01). The alkalinizing effect of bicarbonated Ringer's solution tended to be more marked than that of the acetated solution but not significantly so. Plasma magnesium concentrations were well maintained by bicarbonated solution as compared to the other solutions (P < 0.01). Conclusions: These results suggest that bicarbonated Ringer's solution is the most suitable perioperative solution for metabolic acidosis and plasma electrolyte balance among the Ringer's solutions tested.

Summary

Background and objective: Non-depolarizing neuromuscular blocking agents have differential effects on the diaphragm and skeletal muscles. We employed a new method to study the effects of mivacurium on the diaphragm and compared the results obtained with this method with published data. Methods: Anaesthesia was induced and maintained with propofol and alfentanil and the trachea was intubated after topical anaesthesia. Contractions of the diaphragm were induced by cervical magnetic stimulation of the phrenic nerves and quantified by measuring airway pressure responses. The neuromuscular effects on skeletal muscles were measured by acceleromyography of the adductor pollicis muscle. Mivacurium (0.15 mg kg−1) was injected and neuromuscular responses were recorded until the effects had waned. Results: Eleven male and 10 female patients (ASA I–II; 57 ± 16 yr; 78 ± 13 kg; mean ± standard deviation) participated. Median maximal reduction of twitch response was less (P < 0.05) for the diaphragm (89%) than for the adductor pollicis (100%). Time to 25% recovery was shorter for the diaphragm than for the adductor pollicis (8.8 ± 2.2 min vs. 22.6 ± 5.0 min, P < 0.05). The difference between the recovery index of the diaphragm (7.3 min (3.6–18.4)) and the adductor pollicis (8.2 min (4.4–20.9) (median (range)) just missed our chosen level of statistical significance (P = 0.06). The recovery time to train-of-four 0.8 was shorter for the diaphragm (median and 95% confidence interval 25.1 ± 10.2 min) than for the adductor pollicis (median and 95% confidence interval 37.5 ± 9.4 min, P < 0.05). Conclusions: The duration of the clinical effect of mivacurium on the diaphragm is markedly shorter than on the adductor pollicis muscles but there was only a small difference in the recovery index of the two muscles. These effects and the time courses determined with the new method closely resemble the results obtained with different methods in other studies.

Summary

Background and objective: Emergency research (e.g. into cardiac arrest or head injury) needs to start immediately, often before the patient, or relative, can give consent. A recent European Directive will prevent or severely limit emergency research. Little is known about the public view of emergency research. Methods: Patients attending the outpatient department of a university teaching hospital were invited to complete a self-administered questionnaire. Research Ethics Committee approval was obtained and participants gave written informed consent. Results: Three hundred and five of 362 respondents (84%) thought emergency research should start in the absence of consent but should be obtained as soon as possible from the nearest relative (82%) or the patient (90%). If consent was refused 62% felt the data could still be used, as did 81% if the patient died. Despite 62% approving of public meetings to publicize emergency research only 35% would attend one. A previously recommended list of preconditions was endorsed: no other consentable group (47%); advance consent impossible (55%); unable to delay treatment (73%); consent to be obtained as soon as possible (88%); an adequately designed protocol (74%); Ethics Committee approval (71%); patient may benefit (85%); future patients may benefit (92%) and that the treatment was necessary and could not be delayed (91%). Conclusions: Emergency research must occur to improve the outcome from life-threatening illness or injury. The majority of people are aware of the importance of this research and that the normal rules of consent are not applicable. Alternative methods of recruitment need to be investigated.

Summary

Background and objectives: The aim of this prospective, randomized, controlled clinical study was to evaluate the effects of thoracic epidural anaesthesia combined with isoflurane/nitrous oxide anaesthesia on intraoperative oxygenation during one-lung ventilation for lung resections.

Methods: Forty patients were randomly allocated to receive general anaesthesia maintained with isoflurane/nitrous oxide (group General, n = 20) or the same anaesthetic combined with thoracic epidural anaesthesia (group Integrated, n = 20). All patients were mechanically ventilated with the same settings (FiO2 = 0.5; VT = 9 mL kg−1; inspiratory : expiratory time = 1 : 1; inspiratory pause = 10%). Effects on oxygenation were evaluated by determining the changes in PaO2/FiO2 ratio at 10, 30, 45 and 60 min of one-lung ventilation as compared to values obtained after induction of anaesthesia (supine, two-lung ventilation).

Results: The PaO2/FiO2 ratio was decreased in both groups during one-lung ventilation until the end of surgery. No differences were found at any observation time between the groups. Ventilation with 100% oxygen because of SPO2 decrease <92% was required in nine patients of group General (45%) and in eight patients of group Integrated (40%) (P = 0.64). Manual re-inflation of the operated lung was required in one patient of group General only (P = 0.99). Heart rate was lower in group Integrated than in group General throughout the study. No differences between the two groups in mean arterial pressure were observed.

Conclusions: Adding a thoracic epidural block to isoflurane/nitrous oxide anaesthesia during one-lung ventilation for lung resections does not result in clinically relevant detrimental effects on intraoperative oxygenation.

Summary

Background and objective: The aim of this study was to compare cardiac output (CO) measurements by arterial trans-cardiopulmonary thermodilution (ATD) and pulmonary arterial thermodilution (PATD) with CO estimated on the basis of the Fick calculation via a metabolic monitor in septic shock.

Methods: In a prospective animal study 20 anaesthetized, ventilated pigs (20.9 ± 1.9 kg) were investigated. Septic shock was induced with faecal peritonitis. A pulmonary artery catheter was used for conventional measurement of CO. Simultaneously ATD was measured with a thermistor tipped catheter inserted into right carotid artery. Whole body oxygen consumption was measured by indirect calorimetry. Eighty data pairs of simultaneous CO measurements were analysed.

Results: CO measured with Fick and that measured with PATD were significantly correlated (r = 0.94, r2 = 0.87, P < 0.001). Mean CO measured by PATD was 94.3 ± 40.1 mL min−1 kg−1. Bias was 10.1 mL min−1 kg−1 (95% confidence interval (CI): 6.0–14.2 mL min−1 kg−1) with limits of agreement of −26.8 to 47.0 mL min−1 kg−1 . Correlation between Fick derived CO estimation and ATD CO was similar (r = 0.91, r2 = 0.83, P < 0.001). Mean CO measured by trans-cardiopulmonary thermodilution was 104.3 ± 43.2 mL min−1 kg−1 . Bias was 0.75 mL min−1 kg−1 (95% CI: −3.8 to 5.3 mL min−1 kg−1) with limits of agreement of −39.7 to 41.2 mL min−1 kg−1.

Conclusions: Even during haemodynamic instability in septic shock the correlation of arterial trans-cardiopulmonary thermodilution and PATD derived CO with direct Fick was good. As arterial trans-cardiopulmonary thermodilution is less invasive than PATD, the former may offer practical advantages.

Summary

Background and objectives: Patients undergoing eye surgery under regional anaesthesia often require concomitant medication for analgesia and comfort. Remifentanil, with its ultra-short acting-profile, may be useful to reduce pain during retrobulbar nerve block for cataract surgery.

Methods: We performed a prospective, randomized, double-blind study to compare the efficacy of remifentanil for analgesia during retrobulbar nerve block placement. Ninety patients undergoing cataract surgery were randomly divided to receive either remifentanil 0.3 μg kg−1 (n = 45) or an equivalent volume of saline (n = 45). The injection was administered within 30 s in both groups. Patients rated their amount of pain on a 10 cm visual analogue scale. Respiratory frequency, oxygen saturation, cardiac rhythm and postoperative nausea and vomiting (PONV) were recorded.

Results: The mean visual analogue score in the Remifentanil group was 2.56; it was 5.51 in the Saline group (P = 0.001, U-test). Three patients developed bradycardia and three had PONV in the Remifentanil group. Two patients developed tachycardia and one had PONV in the Saline group. No patient developed respiratory depression.

Conclusion: In patients undergoing retrobulbar block placement for eye surgery, 0.3 μg kg−1 remifentanil over 30 s significantly reduced their reported pain. In addition, remifentanil did not increase the risk of untoward side-effects.

Summary

Background and objective: This prospective, randomized, double-blind study was conducted to evaluate the onset time and duration of sciatic nerve block produced with 0.5% levobupivacaine, 0.75% levobupivacaine and 0.75% ropivacaine.

Methods: Forty-five healthy patients undergoing hallux valgus repair were randomly allocated to receive sciatic nerve block with levobupivacaine 0.5% (n = 15), levobupivacaine 0.75% (n = 15) or ropivacaine 0.75% 20 mL (n = 15). A femoral nerve block was also performed with mepivacaine 2% 15 mL to cover pain related to the thigh tourniquet. A blinded observer recorded the onset time and duration of sciatic nerve block.

Results: The median (range) onset time was 5 (5–40) min with 0.75% levobupivacaine, 30 (5–60) min with 0.5% levobupivacaine and 20 (5–50) min with 0.75% ropivacaine (P = 0.02 and P = 0.12, respectively). Mean (25–75 percentiles) first request for pain medication occurred after 13 (11–14) h with 0.75% ropivacaine, 18 (15–19) h with 0.75% levobupivacaine and 16 (13–20) h with 0.5% levobupivacaine (P = 0.002 and P = 0.002, respectively). Rescue tramadol after surgery was required by three patients in the 0.75% levobupivacaine group, eight patients in the 0.5% levobupivacaine group and nine patients in the 0.75% ropivacaine group (P = 0.05).

Conclusions: We conclude that 0.75% levobupivacaine provides a shorter onset time than 0.5% levobupivacaine and a longer duration of postoperative analgesia than both 0.5% levobupivacaine and 0.75% ropivacaine with reduced need for rescue analgesia after surgery.

Summary

Background and objective: We evaluated the effect of duration of mechanical ventilation with different tidal volumes (VT) on ventilator-induced lung injury in healthy rats. Methods: Anaesthetized rats were ventilated with VT between 9 and 45 mL kg−1 for 1 or 7 h with a positive end-expiratory pressure of 2.5 cmH2O. Results: After 1 h, rats ventilated even with the highest applied VT (36 and 45 mL kg−1, resulting in average peak airway pressures of 30 ± 3 and 37 ± 4 cmH2O), had no detectable alterations in dynamic or static lung mechanics, gas exchange or pulmonary permeability, but a moderate degree of lung inflammation (neutrophil accumulation in broncho-alveolar lavage) observed in all groups. In contrast, after 3 h of ventilation, rats ventilated with the highest VT (36 and 45 mL kg−1) died from progressive circulatory failure and high-permeability pulmonary oedema, manifested by hypoxaemia, an increased alveolar–arterial protein concentration ratio and a reduced static lung compliance (mortality rate at 7 h, 62.5% and 100%). Animals with lower VT all survived and presented no changes in the measured variables. Conclusion: These results in normal rats demonstrate the preponderant effect of the duration (>3 h) of ‘aggressive’ ventilation and the cut-off value of the level of VT applied (>27 mL kg−1).

Summary

Background and objectives: Salt-water aspiration results in pulmonary oedema and hypoxia. We tested the hypothesis that partial liquid ventilation has beneficial effects on gas exchange and rate of survival in acute and extended salt water-induced lung injury. Methods: Anaesthetized, ventilated rats (tidal volume 6 mL kg−1, PEEP 5 cmH2O) received a tracheal salt-water instillation (3%, 8 mL kg−1 body weight) and were randomly assigned to three groups (n = 10 per group). While lungs of Group 1 were gas-ventilated, lungs of Group 2 received a single perfluorocarbon instillation (30 min after the injury, 5 mL kg−1 perfluorocarbon) and lungs of Group 3 received an additional continuous perfluorocarbon application into the treachea (5 mL kg−1 h−1). Arterial blood gases were measured with an intravascular blood gas sensor. Results: Salt-water instillation resulted in a marked decrease in PaO2 values within 30 min (from 432 ± 65 to 83 ± 40 mmHg, FiO2 = 1.0, P < 0.01). Arterial oxygenation improved in all three groups irrespective of treatment. We observed no significant differences between groups in peak PaO2 and PaCO2 values. Conclusions: Our results suggest that partial liquid ventilation has no additional beneficial effects on gas exchange after life-threatening salt water-induced lung injury when compared to conventional gas ventilation with positive end-expiratory pressure.

Summary

Background and objective: Propofol is an intravenous (i.v.) anaesthetic agent that possesses many of the qualities of an ideal anaesthetic agent. The most significant side-effect associated with propofol is pain on injection. Despite optimal therapy, the incidence of pain on propofol injection remains a problem. This prospective, randomized, double blinded study evaluated the effect of three different treatment strategies in decreasing pain on propofol injection.

Methods: We studied 102 adult, ASA I–II patients, scheduled for elective surgical procedures. Combination of i.v. lidocaine and nitrous oxide (N2O) in oxygen (O2) inhalation pre-treatment was compared with either treatment alone in the prevention of pain on propofol injection. A standard propofol injection technique and scoring system, to measure the pain on injection was used.

Results: Demographic variables were similar between the groups. The incidence of no pain on propofol injection was similar in the lidocaine and N2O groups (63.6% vs. 57.5%) (95% confidence interval (CI): 0.17–0.29, P = 0.61). Combination therapy was associated with a greater incidence of no pain on injection (84% vs. 63.6%) (95% CI: 0.06–0.48, P = 0.04).

Conclusion: Combination of i.v. lidocaine and N2O in O2 inhalation pre-treatment is more effective than either treatment alone in decreasing pain on propofol injection.

Summary

Background and objective: Hypotension, especially in elderly and hypovolaemic patients, is frequently associated with intravenous midazolam administration. The mechanisms are not completely understood. This study was designed to investigate the mechanisms involved in the relaxing effect of midazolam on coronary arteries.

Methods: The substance was studied in isolated porcine coronary artery rings precontracted by either potassium chloride or prostaglandin F2α.

Results: Midazolam caused vasodilatation in a concentration-dependent manner. Relaxation was more pronounced in prostaglandin F2α precontracted segments than in those treated with potassium chloride (P < 0.001). Vasodilatation was unaffected by Nω-nitro-l-arginine, indomethacin and glibenclamide. Tetraethylammonium chloride, an inhibitor of the BKCa K+ channel (a high conductance Ca2+-sensitive K+ channel), dose dependently attenuated the vasodilating effect of midazolam (P < 0.01).

Conclusions: Hyperpolarization of the smooth muscle cell in the vessel wall, elicited by the activation the BKCa K+ channel, may contribute to the vasorelaxing effect of midazolam.

Summary

Background and objective: There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal® laryngeal mask airway during pressure support ventilation. Methods: Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 2%, isoflurane end-tidal 1.1% or propofol 6 mg kg−1 h−1 in oxygen 33% and air. Pressure support ventilation comprised positive end-expiratory pressure set at 5 cmH2O, and pressure support set 5 cmH2O above positive end-expiratory pressure. Pressure support was initiated when inspiration produced a 2 cmH2O reduction in airway pressure. A blinded observer recorded cardiorespiratory variables (heart rate, mean blood pressure, oxygen saturation, airway occlusion pressure, respiratory rate, expired tidal volume, expired minute volume and end-tidal CO2), adverse events and emergence times. Results: Respiratory rate and minute volume were 10–21% lower, and end-tidal CO2 6–11% higher with the propofol group compared with the sevoflurane or isoflurane groups, but otherwise cardiorespiratory variables were similar among groups. No adverse events occurred in any group. Emergence times were longer with the propofol group compared with the sevoflurane or isoflurane groups (10 vs. 7 vs. 7 min). Conclusion: Lung ventilation is less effective and emergence times are longer with propofol than sevoflurane or isoflurane for maintenance of anaesthesia during pressure support ventilation with the ProSeal® laryngeal mask airway. However, these differences are small and of doubtful clinical importance.

Summary

Background and objective: The aim of this study was to evaluate prostate anaesthetic block for haemodynamic tolerance and quality of analgesia during and after transurethral surgery. Methods: Ninety adult males, ASA III/IV, were randomly assigned to receive a prostate anaesthetic block (n = 45) or spinal anaesthesia (n = 45). The main outcome measurement during anaesthesia, surgery and recovery was haemodynamic tolerance (number of hypotensive episodes, heart rate, systolic and mean blood pressures). Other outcome variables were pain scores during anaesthesia, surgery and every 4 h until 24 h after the end of surgery and amount of oral morphine required during the 24-h postoperative period. Results: Sixty-six patients were ASA III and 24 ASA IV. Ongoing cardiovascular therapies were comparable between groups. All surgical procedures were performed under good conditions. For patients receiving prostate anaesthetic block, the blood pressure and heart rate did not change significantly during the study period. For patients receiving spinal anaesthesia, the hypotension rate was 55.6% (n = 25) compared to 0 in the prostate anaesthetic block group (P < 0.001); 25 and 4 patients, respectively, required vascular filling and additional ephedrine administration. In both groups, all pain scores were <40 (100 mm visual analogue scale) during the study period. Oral morphine was given during the postoperative period to two prostate anaesthetic block patients and four who had received spinal anaesthesia (not significant). Conclusion: Transurethral surgery under prostate anaesthetic block is safe and assures adequate analgesia during and after surgery.

Summary

Background and objective: Recent studies have suggested that cytochrome P-450 isoenzyme 1A2 has an important role in lidocaine biotransformation. We have studied the effect of a cytochrome P-450 1A2 inhibitor, ciprofloxacin, on the pharmacokinetics of lidocaine. Methods: In a randomized, double-blinded, cross-over study, nine healthy volunteers ingested for 2.5 days 500 mg oral ciprofloxacin or placebo twice daily. On day 3, they received a single dose of 1.5 mg kg−1 lidocaine intravenously over 60 min. Plasma concentrations of lidocaine, 3-hydroxylidocaine and monoethylglycinexylidide were determined for 11 h after the start of the lidocaine infusion. Results: Ciprofloxacin increased the mean peak concentration and area under plasma concentration–time curve of lidocaine by 12% (range −6 to +46%; P < 0.05) and 26% (8–59%; P < 0.01), respectively. The mean plasma clearance of lidocaine was decreased by ciprofloxacin by 22% (7–38%; P < 0.01). Ciprofloxacin decreased the area under the plasma concentration–time curve of monoethylglycinexylidide by 21% (P < 0.01) and that of 3-hydroxylidocaine by 14% (P < 0.01). Conclusion: The plasma decay of intravenously administered lidocaine is modestly delayed by concomitantly administered ciprofloxacin. Ciprofloxacin may increase the systemic toxicity of lidocaine.

Summary

Background and objective: This prospective, double-blind, randomized, placebo-controlled study compares the effects of ephedrine and ketamine on injection pain, and hypotension from propofol.

Methods: After obtaining the approval of the Ethics Commitee, 75 patients (ASA I–II) scheduled for elective operations with general anaesthesia were divided into three groups. Saline 2 mL (Group S, n = 25), ketamine 0.5 mg kg−1 (Group K, n = 25) or ephedrine 70 μg kg−1 (Group E, n = 25) were administered over 5 s after tourniquet application. After releasing the tourniquet, propofol 2 mg kg−1 was injected in 30 s. Pain was evaluated on a numerical scale (0–10) where 0 represented no pain and 10 the most severe pain possible. Systolic, diastolic blood pressures and heart rates were recorded preoperatively, 1 min after propofol injection, before intubation and 1, 2 and 3 min after intubation in all patients.

Results: The incidences of pain in Groups S, E and K were similar (84%, 80% and 72%, respectively). The mean pain score in Group K (2.1, SD 3.1) was significantly lower than those of Groups S and E (4.9, SD 2.6 and 4.6, SD 3.3, respectively) (P < 0.05). The systolic and diastolic blood pressure values in Group K (120 ± 27 mmHg) and Group E (123 ± 21 mmHg) before intubation were significantly higher than that of Group S (104 ± 25 mmHg) (P < 0.05). There was no significant difference between the mean heart rate values of the groups.

Conclusions: Low dose ketamine or ephedrine pretreatment may prevent hypotension due to propofol induction. Despite the reduction in injection pain intensity after ketamine, the study drugs were found to be ineffective in lowering the injection pain incidence.

Summary

Background and objective: Transfusion of blood components can trigger immunological reactions which may result in a transfusion-related acute lung injury (TRALI). The reported incidence is low; however, there is increasing evidence that the true incidence of this complication may be much higher. One reason for underdiagnosing TRALI could be a deficiency of knowledge about this complication. Therefore, we studied the level of knowledge concerning TRALI among clinicians working on intensive care units (ICU) of an university teaching hospital.

Methods: A total of 65 clinicians were asked to complete a confidential questionnaire designed to evaluate their knowledge about incidence, pathophysiology, clinical symptoms, therapy and outcome of TRALI. This questionnaire consisted of 13 questions which could be assessed by ‘yes’, ‘no’ or ‘do not know’.

Results: Only 42 ± 18% (mean ± SD) of all answers were correct, while 33 ± 17% were wrong and 25 ± 8% unanswered (‘do not know’). The 95% confidence interval for the correct answers was 30.8–53.8% implying that there was no significant difference compared to the probability of arbitrary guessing (33.3%).

Conclusions: Our survey uncovered a marked deficit of knowledge about TRALI suggesting that the low reported incidence of this complication may be in part due to a lack of awareness for TRALI. We conclude that training programmes for clinicians should alert them to the symptoms, diagnosis and treatment options of TRALI.

Summary

Background and objective: Adding various opioids to the local anaesthetic solution administrated intrathecally improves the analgesic potency of spinal analgesia. The purpose of this study was to evaluate the efficacy and safety of intrathecal fentanyl 10 μg added to 15 mg hyperbaric ropivacaine in patients undergoing caesarean section under spinal anaesthesia.

Methods: Thirty-seven healthy, full-term parturients were randomly assigned into two groups: Group S (saline group, n = 17) received 15 mg hyperbaric ropivacaine in 2.5 mL + 0.5 mL saline; Group F (fentanyl group, n = 20) received 15 mg hyperbaric ropivacaine in 2.5 mL + 10 μg fentanyl in 0.5 mL, intrathecally. Characteristics of spinal block, intraoperative quality of spinal anaesthesia, time to first feeling of pain (complete analgesia), time to first request of analgesics postoperatively (effective analgesia), side-effects and fetal outcomes were evaluated.

Results: Regression of sensory block to L5 was significantly prolonged in the fentanyl group compared with the saline group (P = 0.001). Time to the first feeling of pain (130.6 ± 15.8 min vs. 154.3 ± 31.1 min; P = 0.008) and the first analgesic requirement (161.2 ± 32.6 min vs. 213.0 ± 29.3 min; P < 0.001) were significantly shorter in the saline group compared with the fentanyl group. Side-effects, umbilical arterial and venous blood gases did not differ between the groups. Apgar scores were similar in both groups and no infants had an Apgar score ≤7 at 5 min.

Conclusions: The addition of fentanyl 10 μg, to hyperbaric ropivacaine 15 mg, for spinal anaesthesia increased the duration of analgesia in the early postoperative period in patients undergoing caesarean delivery.