This study was designed to compare the anesthetic properties of hypobaric bupivacaine with those of isobaric and hyperbaric solutions when administered in the supine position in an elderly population undergoing hip surgery using continuous spinal anesthesia. Plain bupivacaine (0.5%) was mixed with equal volumes of 10% dextrose (hyperbaric), 0.9% NaCl (isobaric), or distilled water (hypobaric) to obtain 0.25% solutions. In a double-blind fashion, all patients received 3 mL (7.5 mg) of their particular solution injected through the spinal catheter in the horizontal supine position. The sensory level obtained in the hyperbaric group (median, T4; range, T3-L3) was significantly higher than in both the isobaric (median, T11; range, T6-L1) and hypobaric (median, L1; range, T4-L3) groups. A motor blockade of grade 2 or 3 was obtained in 14 of 15 and 12 of 15 patients in, respectively, the hyperbaric and isobaric groups, but only in 8 of 15 patients in the hypobaric group. After the initial injection of 3 mL (7.5 mg), a sensory level of T10 and a motor blockade of grade 2 or 3 was obtained in 14 of 15, 5 of 15, and 3 of 15 patients in the hyperbaric, isobaric, and hypobaric groups, respectively. All remaining patients received 1 or 2 additional milliliters (2.5-5 mg) and achieved these required anesthetic conditions, except for one patient in the hyperbaric group and eight patients in the hypobaric group in whom anesthesia was achieved with hyperbaric tetracaine. The decrease in mean arterial pressure was significantly more severe in the hyperbaric (30%) than in either the isobaric (18%) or hypobaric (14%) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment and certification processes in European anaesthesia training are diverse. In many countries, a time-based apprenticeship model is evolving towards a competency-based certification process. This diversity precludes comparison of competence of graduating anaesthetists across Europe.

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In a search of a differential spinal block between dependent and nondependent sides, we investigated whether the use of a larger concentration of hyperbaric tetracaine (T) and/or the omission of epinephrine (E) would provide differential spread in patients left for 15 min in the lateral decubitus position. Spinal anesthesia was performed in the lateral decubitus position with the operated side dependent in 60 patients scheduled for lower limb surgery. All patients remained lateral for 15 min after spinal injection before being turned supine. They received 12 mg of T in 10% dextrose and E 0.2 mg was added when predicted duration of surgery was more than 90 min. The concentration of T to be used for each patient was randomized. This resulted in four groups of 15 patients: T 0.5% + E (control group), T 1% + E, T 0.5%, and T 1%. A unilateral anesthesia was defined as the presence of an adequate sensory (L-1 or higher) and/or motor (3 degrees) blockade on the dependent side and the absence of one or both modalities on the nondependent side, or as a duration of sensory (regression to L-2) and motor (1 degrees of recovery) blockade 20% longer on the dependent compared to the nondependent side. None of the 60 patients showed unilateral sensory block. A comparable number of patients in all groups showed unilateral motor block: four in T 0.5% + E, two in T 1% + E, four in T 0.5%, and five in T 1%. Likewise, a comparable number of patients in all groups showed a prolonged duration of sensory and motor block, respectively: six and eight in T 0.5% + E, six and nine in T 1% + E, six and eight in T 0.5%, and seven and seven in T 1%. In conclusion, although a preferential distribution of hyperbaric T toward the dependent side in patients of all four groups was noticed, the use of a larger concentration of T, omission of E, or combination of these two factors did not provide a more marked differential spread when compared to the standard solution of T 0.5% + E.