To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 micrograms sufentanil in 6-10 mL bupivacaine 0.125% via a lumbar or thoracic catheter. After 1 h, a continuous infusion was started with 50 micrograms sufentanil in 50 mL bupivacaine 0.125% at a rate of 6-10 mL/h. The infusion was continued postoperatively for 1-5 days or longer, depending on the type of operation and the patient's analgesic need. In the majority of patients, adequate pain relief was obtained at rest and during movement. Late respiratory depression was observed in three patients; in most patients only minor side effects were seen. Technical complications during epidural puncture or insertion of the catheter were 4% and 3%, respectively. We conclude that continuous epidural sufentanil and bupivacaine is safe and effective.

No abstract

No abstract

To assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n = 20, ES group) or 10 ml normal saline (n = 20, control group) via a thoracic epidural catheter. The study solution was given (double-blind and at random) after the patients had been anaesthetized with i.v. midazolam, sufentanil and vecuronium. Anaesthesia was maintained with 60% nitrous oxide in oxygen and halothane at a 1% inspiratory concentration. When patients showed signs of inadequate analgesia, supplementary doses of 25 mu g sufentanil were given i.v. The number of patients requiring additional i.v. sufentanil differed significantly between the two groups: 5 out of 20 patients in the ES group vs 13 out of 20 patients in the control group required additional sufentanil (P<0.05). The mean dose administered i.v. did not differ significantly between the two groups: 105 +/- 109.5 mu g vs 138.5 +/- 126.9 mu g (mean +/- SD) in 5 and 13 patients, respectively. No cardiovascular changes were observed after the epidural bolus dose. Postoperative analgesia, consisting of a continuous epidural infusion of 50 mu g sufentanil in 50 ml bupivacaine 0.125% at a rate of 6-10 ml/h after a bolus dose of 10 ml of this solution, was adequate in the majority of patients, as determined by VAS-scores assessed during the epidural treatment (4.3 +/- 1.5 days).

SummaryAn acute episode of a maiignant hyperthermia-like syndrome is described which occurred after suxamethonium and isofurane anaesthesia in a 41-year-old healthy male patient undergoing a minor elective hand operation. Dantrolene therapy rapidly reversed the lfe-threatening signs. Laboratory results appeared to confrm the suspicion of malignant hyperthermia. However, the in vitro contracture test, which was carried out according to the standards of the European Malignant Hyperthermia Group. was equivocal. Key wordsAnaesthetics, volatile; isoflurane. Hyper thermia; malignant. Neuromuscular relaxants; suxamethonium.Malignant hyperthennia (MH) is a dangerous complication of anaesthesia. The combination of suxamethonium and a potent volatile anaesthetic agent can act as a trigger, but MH is not frequently associated with isoffurane anaesthesia. In 1982 the first case of MH after isoflurane anaesthesia was described; however, it was not confirmed by a positive in vilro contracture test.' Since then six more cases have been reported, three of whom were confirmed by a positive test.2 Case historyA 41-year-old male patient, weighing 85 kg presented for a local excision of a tumour on the radial side of his left wrist. He had undergone two previous anaesthetic procedures without any complication and was assessed as ASA I . No premedication was given. After insertion of an intravenous line, an interscalene brachial plexus block was performed with 40 ml bupivacaine 0.375% and adrenaline 1:400 000. Anaesthesia, as assessed by pinprick 20 minutes after the injection, appeared to be adequate. However, at skin incision, this proved not to be so, therefore the patient was anaesthetised with thiopentone 425 mg and given suxamethonium 100 mg to facilitate intubation of the trachea. The anaesthetist noticed that the muscles of the neck were rigid, but tracheal intubation was uneventful. Controlled ventilation of the lungs was instituted (Drager: Ventilog 2) and carbon dioxide (CO,) output monitored by capnography (Datex). Anaesthesia was maintained with 30% oxygen in nitrous oxide and isoflurane 1% and a bolus dose of fentanyl 0.15 mg was given. Five minutes after intubation a rapid rise in the end-tidal CO, was noticed (7.8%) despite apparently adequate ventilation. Auscultation of the lungs and ventilatory pressures were normal, expansion of the chest wall was symmetrical and there were no signs of any leak of gas from the breathing system. The ventilator and the capnograph were checked and no defects were found. In 15 minutes the end-tidal C 0 2 increased from 4.1% to greater than 10% (Fig. 1). The heart rate increased to 129 beats/minute, but the blood pressure remained stable. There was no cyanosis and pulse oximetry showed an oxygen saturation of 97%. Blood gas analysis 30 minutes after the induction of anaesthesia revealed a respiratory acidosis (pH 7.11; Paco, 10.4 kPa).Although the temperature of the skin felt normal, MH was suspected. Isoflurane was discontinued and the patient's lungs were hyperventilated with 100%...