These findings confirm that THC can induce a transient, acute psychotic reaction in psychiatrically well individuals. The extent of the psychotic reaction was not related to the degree of anxiety or cognitive impairment.

Tracheal intubation by critical care doctors in Scotland has a higher first-time success rate than described in previous reports of critical care intubation, and technical complications are few. Doctors carrying out intubation had undergone longer formal training in anaesthesia than described previously, and junior trainees are routinely supervised. Despite these good results, further work is necessary to reduce physiological complications and patient morbidity.

The main factor limiting organ donation is the availability of suitable donors and organs. Currently, most transplants follow multiple organ retrieval from heartbeating brain-dead organ donors. However, brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval. In some cases, this prevents successful donation. There is increasing evidence that moderation of these pathophysiological changes by active management in Intensive Care maintains organ function, thereby increasing the number and functional quality of organs available for transplantation. This strategy of active donor management requires an alteration of philosophy and therapy on the part of the intensive care unit clinicians and has significant resource implications if it is to be delivered reliably and safely. Despite increasing consensus over donor management protocols, many of their components have not yet been subjected to controlled evaluation. Hence the optimal combinations of treatment goals, monitoring, and specific therapies have not yet been fully defined. More research into the component techniques is needed.

No abstract

Ropivacaine, a new long acting amide type local anaesthetic, was compared with bupivacaine in a randomized double-blind study. One hundred and ten patients undergoing extradural anaesthesia received a test dose of 3 ml of 1% lignocaine with adrenaline which was followed by 15 ml of one of five solutions: 0.5, 0.75 or 1.0% ropivacaine or 0.5 or 0.75% bupivacaine. There was little difference between the groups with respect to speed of onset or sensory block. The duration of analgesia was increased by increasing the concentration of both drugs, but this had minimal effect on onset time or extent of block. When the same concentration of each drug was administered, there were inconsistent differences in duration of sensory block, none of which was statistically significant. Increasing concentration of both drugs resulted in greater degree and longer duration of motor block. Ropivacaine produced a slower onset, shorter duration and less intense motor block than the same concentration of bupivacaine. The cardiovascular changes were similar in all groups.