This study was designed to evaluate whether there is any scientific basis for clinicians' preferences for selecting opioids for use in patient-controlled analgesia (PCA) and to determine whether there are any patients' preferences for being treated with any of these opioids. Results were obtained for 55 postoperative patients recruited to investigate putatively equivalent doses of 3 commonly used opioids--morphine, pethidine and fentanyl--when self-administered postoperatively. No significant differences in the incidence of side effects between groups were found with the exception of more pruritus reported in the group given morphine. Patients who experienced vomiting or pruritus reported a greater intensity of these side effects if receiving morphine and fentanyl than if receiving pethidine. The majority of patients reported being very satisfied with their postoperative pain management and with PCA, with no differences in satisfaction between the 3 opioid-treated groups. A senior consultant anaesthetist, when asked to make a judgement, was not able to identify which agent each patient was receiving with a better than chance accuracy. These findings suggest that while there may be subtle differences in patient response to these 3 commonly used opioids, none was obviously superior when used for postoperative PCA.

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Plastic surgery patients undergoing either local (LA) or general (CA) anaesthesia of at least fortylive minutes' duration and a non-patient control group were used to examine the extent and duration 0/ deterioration in rnental functioning following CA and the factors influencing such deterioration. Mental jilflctioning was assessed by a ba{(ery of six tests administered one week before anaesthesia, four days after anaesthesia and six weeks after anaesthesia. Mental performance of CA patients but not of LA patients was significantly impaired on the fourth postoperative day. Six weeks ajrer anaesthesia CA patients were still per/orming significantly below controls. There was marked variation in the pallern of recovery, some CA patients failing to regain their pre-operative level 0/ performance after six weeks. Severity of deterioration jollowing general anaesthesia was significantly correlated with habitual ca/leine consllmption.

The peripheral and central nervous, cardiovascular and respiratory effects of midazolam 0.15 mglkg, administered intravenously, were studied in 57 patients. Midazolam induced anaesthesia satisfactorily in 78% of the patients, the remainder required either further doses of midazolam, or alternative induction agents. There was no pain on injection. No evidence of thrombophlebitis was apparent up to 72 hours after injection. Mean systolic arterial pressure decreased from 128 mm Hg to 114 mm Hg and mean diastolic pressure decreased from 75 mm Hg to 67 mm Hg (P < 0.005) four minutes after injection. Mean heart rate increased from 81 beatslmin to 88 beatslmin (P < 0.005) one minute after injection. Apnoea occurred in 14 patients, with a mean onset time of 82 sec and a mean duration of 30 sec. Patients showed a decrease in mean respiratory rate from 13.7 breathslmin to 12.8 breathslmin two minutes after injection of midazolam. A larger dose than used in this study would be necessary for satisfactory use of midazolam as an induction agent for general anaesthesia.