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SummaryIn order to avoid Cremophor-related reactions and reduce the incidence of pain on injection, diisopropylphenol (ICI 35,868; propof) Key wordsAnaesthetics, intravenous; propofol.2,6-di-isopropylphenol (ICI 35,868; propofol; 'Diprivan,' formerly disoprofol) is one of a series of alkylphenols which were found to have anaesthetic properties in animals.' Initial investigations of the pharmacological properties of propofol were conducted using a formulation containing the surfactant Cremophor EL.2 Anaesthetic properties were demonstrated in who received 1-3 mg/kg intravenously although in unpremedicated patients 2 mg/kg was generally successful. s * 7 There was pain on when the drug was given into veins on the dorsum of the hand. To reduce the frequency of this side-effect, and because of circumstantial evidence of a n association of Cremophor-containing agents with anaphylactoid reactions,10-12 an emulsion formulation of propofol has been developed. We have determined the effective dose of propofol* in the new emulsion formulation for induction of anaesthesia in 95% (AD 95) of healthy, unpremedicated patients. MethodsFive hospitals in the United Kingdom participated in an open study for which individual hospital ethics committee approval had been G

Background/aims Levobupivacaine, the S(-)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia. Methods A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and orbicularis oculi function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block. Results The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (P ¼ 0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration vs time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor

Subarachnoid anaesthesia was induced in 40 patients with 0.5% bupivacaine 3 ml with no glucose, 5% glucose or 8% glucose, or with hyperbaric cinchocaine . The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects, and the frequency of side-effects were studied. The hyperbaric solutions produced a greater cephalad spread (T6-T7) than the glucose-free solution (T10-T11). Cinchocaine produced a longer duration of action at T10 and T12 than the hyperbaric bupivacaine solutions. No advantage was seen when 8% rather than 5% glucose was used. The glucose-free bupivacaine produced intense blockade of long duration and was suitable when a lower level of blockade was adequate for the proposed surgery.

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