Purpose: Postanaesthetic shivering occurs in 5-65% of patients. In addition to causing discomfort, it is associated with deleterious consequences. Our objective was to investigate the effect of 150/ag clonidine, at induction of anaesthesia, on perioperative core and peripheral temperature, incidence of postanaesthetic shivering and patients' perception of cold. Methods: Sixty ASA I or 2 patients scheduled for elective orthopaedic limb surgery were randomly allocated to group I, who received 150/Jg clonidine iv, or group 2, who received a saline bolus iv, before induction. In alI patients, anaesthesia was induced with fentanyl and propofol and maintained by spontaneous respiration (via a laryngeal mask airway) of oxygen, nitrous oxide and enflurane. Core (nasopharyngeal) and peripheral (dorsal hand) temperatures were recorded at induction and 15-rain intervals. Nurses, unaware of the treatment groups, recorded visible shivering in the recovery room, When cognitive function returned, patients were asked to grade their perception of cold on a I 0 cm linear analogue scale, higher scores indicating heat discomfort.Results: While core temperature decreased and peripheral temperature increased in both groups, there was no difference between the groups at any time. However, there was a lower incidence of shivering in the clonidine group (20% vs 66.7% P <0.00l ). Patients receiving clonidine felt warmer; thermal comfort score (median interquartile range) 5.9 (5.0-7.2) vs 5.0 (4.5-6.0), P <0.05).Conclusion: Clonidine 150 g iv at induction of anaesthesia reduces the incidence of shivering and patients' subjective perception of cold on emergence from general anaesthesia. R~sultats : Alors que la temp&ature centrale diminuait et la temp&ature pEriphErique augmentait dans les deux groupes, aucune difference if&at notEe entre les groupes. Cependant, I'incidence du flisson Etalt plus basse dans le groupe clonidine (20% vs 66,7%, P <0,00 I). La perception de chaleur Etait plus ElevEe chez les patients sous clonidine avec un score de comfort (mEdiane &art interquartile de) 5,9 (5,0-7,2) vs 5,0 (4,5-6,0), P <0,05). Conclusion : AdministrEe ~. (induction, la donidine iv r~duit rincidence du fdsson et [a sensation subjective de froid per~ue au r~veil apr~s une anesth&ie gEn&ale.

SummaryRoutine pre-operative evaluation of a 58-year-old man scheduled for repair of an inguinal hernia, disclosed a blood pressure of 200/100 mmHg. This decreased to 150/100 mmHg after a period of rest. An electrocardiogram taken as a result of this chance finding showed left bundle branch block. There were no other cardiovascular symptoms or signs. Soon after induction of general anaesthesia, the conduction defect disappeared. The return to sinus rhythm was sudden and sustained and was not related to changes in heart rate or blood pressure. One month later, his electrocardiograph remained normal. Intermittent left bundle branch block is uncommon and its development during anaesthesia more so [1, 2]. It must be distinguished from the more common intermittent bundle branch block, where both normal and abnormal complexes are seen in the same electrocardiogram (ECG) record. Although there are a number of causes of right bundle branch block, left bundle branch block (LBBB) is most frequently associated with ischaemic heart disease [3, 4]. Particular care is needed when anaesthetising patients who have LBBB. They should be managed with the same delicacy as patients who have significant ischaemic heart disease.We present a case of a patient in whom LBBB, an incidental finding during pre-operative screening, reverted to sinus rhythm during anaesthesia. Because myocardial ischaemia is unlikely to lessen during anaesthesia, an asymptomatic patient whose ECG shows LBBB represents a significant dilemma for the anaesthetist. Case historyA 70-kg, 58-year-old Caucasian male, with a body mass index of 23.1, was scheduled for repair of right inguinal hernia under general anaesthesia. Pre-assessment disclosed only a history of a single episode of fainting many years before. Clinical examination was unremarkable. He did not receive any medication and had no known allergies.On admission, the patient's blood pressure was found to be elevated at 200/100 mmHg. This settled within a few hours but he remained mildly hypertensive with a blood pressure of 150/100 mmHg. His pulse rate was 90 beat. min ÿ 1 . Re-examination showed all pulses were normal, that the apex beat was not displaced and heart sounds were normal. There was no evidence of congestive heart failure. A chest X-ray was reported normal. His routine biochemical and haematological tests were within the normal limits. An ECG, obtained because of the chance finding of hypertension, showed normal sinus rhythm with a heart rate of 85 beat.min ÿ 1 and LBBB (Fig. 1). Following reassessment, no further investigations were considered appropriate or necessary because the patient gave no history suggestive of ischaemic heart disease and had an excellent exercise tolerance.He received no premedication. Before induction of anaesthesia, routine monitors (electrocardiography (CM5), oxygen saturation and noninvasive blood pressure) were placed and baseline observations made. He was preoxygenated with 100% oxygen. Anaesthesia was induced 684ᮊ 1997 Blackwell Science Ltd with thiopentone 40...

We report on the perioperative management of anesthesia and analgesia in a child with sickle cell disease and a congenital myopathy, presenting for corrective orthopedic surgery. The case illustrates two valuable points of interest: the many benefits of regional anesthesia in complex medical cases and the successful use of tourniquets in children with sickle cell disease.

The practice of routinely prehydrating patients by infusing a crystalloid or colloid solution (up to 1.0 L/70 kg) for prevention of spinal anesthesia-induced hypotension has been challenged recently, after several reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor therapy after spinal anesthesia and no prehydration with crystalloid and colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were randomized to receive 500 mL crystalloid solution (Hartmanns, n = 29), 500 mL colloid (Haemaccel, n = 28), or no prehydration (n = 28) over 10 min prior to spinal anesthesia. Hypotension was defined as a 30% decrease from baseline systolic blood pressure (BP) or systolic < 90 mm Hg, and was treated with ephedrine 3-mg boluses. Although absolute systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrine use, incidence of nausea/vomiting, and median total dose of ephedrine were similar in all groups. We conclude that, in elderly patients undergoing elective procedures, withholding prehydration is not associated with any greater degree of hypotension or need for vasopressor therapy compared with crystalloid or colloid prehydration.

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