SummaryOne hundred adult patients attending for day case surgery were surveyed by anonymous questionnaire in order to determine their attitudes to rectal drug administration. Fifty four patients did not want an analgesic drug (diclofenac sodium) administered rectally whilst under anaesthesia, allpreferring to take it orally ifavailable. Ninety eight patients thought that drugs administeredper rectum should always be discussed with them beforehand and a few had very strong feelings about this route of administration. We suggest that prescribers of rectal diclofenac should always discuss it with patients pre-operatively. Whilst many are happy to have suppositories, some young patients are sensitive about this and prefer to take such medication by mouth. Key words Medicolegal.Anaesthetics; rectal. Analgesics; diclofenac.Non-steroidal anti-inflammatory drugs are an important part of the anaesthetist's armamentarium in the prevention of postoperative pain following surgery [ 1-31. Diclofenac sodium is one that is commonly administered, often by rectal suppository. We have conducted a survey to explore the attitudes of patients to the administration of analgesic drugs per rectum. Some people are sensitive about this part of the anatomy [4,5] and since many patients now expect to be involved in choice of therapeutic or anaesthetic technique, this may have implications for anaesthetists. MethodsOne hundred adult patients attending for surgery at a District General Hospital Day Case Unit were asked to complete a short questionnaire to find out their views about a routine procedure in our unit. The questionnaire (Fig. 1) defined precisely what rectal drug administration involved, in this instance to be performed by a nurse after induction of general anaesthesia. It also informed the patient of the analgesic benefit of the procedure and also of the other options available, which include taking diclofenac orally. Possible side effects were outlined, namely proctitis when administered per rectum, and epigastric pain when taken orally.Patients were asked if they were happy to have a drug administered per rectum whilst they were in the operating theatre. They were asked if they would prefer to take the drug by mouth and also if they considered that rectal administration should be discussed with them beforehand.Further comments were invited. Questionnaires remained anonymous, although the patient's age, sex and the proposed surgery were recorded.

SummaryA survey by questionnare was carried out to look into the provision of facilities for the secondary transfer of head injuredpatients, as well as d@culties encountered. An 84.6% response rate was achieved from 110 hospitals in six regions in the south of England. The results showed that 21 % of hospitals had been unable to make a transfer in the previous year, and delays were commonly experienced by 23.7% of hospitals. The nursing attendance during transfer was satisfactory, but the quality of medical escort was poor, and the standard of monitoring equipment available was unacceptable. Methods of improving the situation include implementation of the recommendations of the Royal College of Surgeons, as well as the Association of Anaesthetists' recommendations for standards of monitoring and provision of intensive care.

Paired train-of-four (TOF) and double burst stimuli (DBS) were administered to the ulnar nerve at the wrist in 25 patients (group 1) paralysed with atracurium 0.5 mg kg-1; responses were measured mechanically (except every third DBS response which was manually evaluated). Another 30 patients (group 2) received a DBS every 60 s. A post-tetanic count (PTC) was performed when the first response (D1) was palpated. There was a significant correlation between the twitch heights of the first TOF response (T1) and D1 and likewise between the twitch heights of both second responses (r = 0.9; P less than 0.001), but there was a significant difference in regression coefficients of these two correlations (P less than 0.001). D1 was palpable first with a median PTC of 7. Our results showed that palpation of a single response implied a satisfactory level of paralysis. DBS may be useful for intraoperative clinical monitoring of neuromuscular block.

SummaryA prospective study of 128 adult cardiac surgical patients was undertaken in order to quantify net magnesium loss and its relationship to serum magnesium levels and postoperative problems, particularly arrhythmias. Peri-operative magnesium flux on the first day was calculated from the administered magnesium (in cardioplegia solution and intravenous infusion) and urinary magnesium loss. Magnesium input ranged from 24 mmol to 40 mmol, resulting in a net magnesium gain in 94% of patients. Hypomagnesaemia, identified in 34% of patients pre-operatively and 30% of patients postoperatively, had no significant correlation with the measured peri-operative magnesium flux or the electrocardiograph corrected-QT interval. Fifty-three patients developed postoperative arrhythmias, but there was no significant correlation with the serum total magnesium concentration, or with the peri-operative change in serum magnesium level, magnesium flux. or QT interval. The data suggest that serum total magnesium is not a useful measurement upon which to base preventive or therapeutic measures in cardiac surgical patients.