The reverse-Trendelenberg position effectively lowers the CVP during liver surgery. It is easy to monitor, titrate and reverse, and avoids the need for complex pharmacological interventions. We recommend this position to liver surgeons and anaesthetists who have found it difficult to maintain a low CVP with the supine or Trendelenberg positions.

No abstract

The syndrome of haemolysis, elevated liver enzymes and low platelets is a rare condition specific to pregnancy, affecting approximately 5-20% of all pre-eclamptic pregnancies. Described here is a woman in her first pregnancy, who experienced an intrauterine death following a significant hepatic haematoma and capsular rupture, in the absence of classical clinical features suggestive of pre-eclampsia. The events that followed suggested haemolysis, elevated liver enzymes and low platelets syndrome as the likely diagnosis. The patient's clinical course highlights the difficulties that may be encountered when making decisions about pregnant women with complicated medical and obstetric issues.

The effect of applying nitroglycerin or placebo ointment to the back of the hand before venipuncture and injection of propofol was investigated in 60 ASA physical status I unpremedicated women. Eighteen patients (67%) pretreated with nitroglycerin experienced no pain compared with 10 (33%) in the placebo group. Eleven in the placebo group experienced moderate or severe pain during injection compared with only one in the active group. The time of onset of pain in more than half the subjects occurred 10 s or longer after commencement of injection, and, in more than half the patients, the site at which pain was felt was above the injection site (with three subjects experiencing it in the shoulder). No patient had a headache or experienced postural hypotension. We conclude that nitroglycerin ointment applied to the back of the hand before injection reduces the incidence of painful injection with propofol.