Summary Sixty boys aged up to 9 years undergoing orchidopexy were randomly allocated to receive one of three solutions for caudal epidural injection: group A received 1 ml. kg−1 of 0.25% bupivacaine with 0.25 mg. kg−1of preservative‐free ketamine, group B received 1 ml. kg−1 of 0.25% bupivacaine with ketamine 0.5mg. kg−1 and group C received 1 ml. kg−1 of 0.25% bupivacaine with 1 mg. kg−1 of ketamine. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 7.9h in group A, 11 h in group B and 16.5 h in group C. There were no differences between the groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Group C had a significantly higher incidence of behavioural side effects, including slightly odd behaviour, vacant stares and abnormal effect than groups A and B.

SummaryWe have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.Keywords Anaesthetic techniques, regional; epidural, thoracic. Surgery ; coronary artery bypass grafts. Complications ; postoperative. ...................................................................................... Correspondence to: Dr N. B. Scott Accepted: 2 March 1997 In recent years there has been a growing interest in the use of thoracic epidural anaesthesia for coronary artery bypass surgery. Its potential advantages include excellent analgesia [1], improved pulmonary function [2], early tracheal extubation [2, 3] and cardiac protection as a result of sympathetic blockade [4]. Thoracic epidural anaesthesia decreases the stress response to sternotomy and cardiopulmonary bypass. Increased sympathetic activity may lead to an increase in arterial pressure, tachycardia and an imbalance between the myocardial oxygen demand and supply, with increased myocardial oxygen extraction and the possibility of ischaemic episodes. Moore et al. showed that plasma concentrations of adrenaline and noradrenaline did not increase in the first 24 h after cardiac surgery in patients receiving thoracic epidural anaesthesia compared with a conventional anaesthetic technique [5]. Other studies have shown that haemodynamic stability was maintained during and after surgery using thoracic epidural anaesthesia [6][7][8][9].Thoracic epidural anaesthesia has been shown to decrease pain and improve the endocardial to epicardial blood flow ratio, thereby decreasing the number of ischaemic episodes [10][11][12]. Thoracic epidural anaesthesia has also been shown to decrease infarct ...

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Correspondence markedly than in non-and exsmokers [I], and is dependent on tidal volume [2]. I ventilated the lungs of 58 patients at two settings (firstly at 17 breath.min-l, volume 0.4-0.51, and than at 9 breath.min-l, volume 0.7-0.81), so that group mean Paco, was the same at both settings. At small volumes, median Paco,-PE'co, and the 5th and 95th percentiles were 0.6, 0.2 and 1.4 kPa; at large they were 0.3-0.1 and 1.1 kPa. Mean Paco,-PE'co, was thus 0.3 kPa less at the larger tidal volume; in some young patients Paco2-PE'co2 was small and did not change much with ventilator setting. Pace,-PE'co, was greater in patients with delayed pulmonary emptying, i.e. airways obstruction.The capnograph and pulse oximeter allow excellent monitoring of ventilation. Ventilator systems are bulky enough; the variable deadspace is unnecessary.

Forty boys aged from one to five years undergoing orchidopexy were randomly allocated to receive one of two solutions for caudal epidural injection. Group A received 1 ml.kg-1 of 0.125% bupivacaine with ketamine 0.5 mg.kg-1 and Group B received 1 ml.kg-1 of bupivacaine 0.25% with ketamine 0.5 mg.kg-1. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 8 h in Group A compared with 9.5 h in Group B (P<0.05). The time taken to recover the ability to walk was a median of two h in Group A and three h in Group B (P<0.05). There were no differences between the groups in the incidence of urinary retention or postoperative sedation.