I.V. administration of CSL 30 ml kg(-1) to healthy women undergoing day-case gynaecological laparoscopy reduced the incidence of vomiting, nausea and anti-emetic use when compared with CSL 10 ml kg(-1).

P Pu ur rp po os se e: : To examine the effects of iv compound sodium lactate (CSL) with and without caloric supplementation with dextrose on nausea, vomiting and pain following general anesthesia for laparoscopy.

The efficacy of currently available antiemetics remains poor. Concern with their side effects and the high cost of the newer drugs has led to renewed interest in non-pharmacological methods of treatment. We have studied the efficacy of acupressure at the P6 point in the prevention of nausea and vomiting after laparoscopy, in a double-blind, randomized, controlled study of acupressure vs placebo. We studied 104 patients undergoing laparoscopy and dye investigation. The anaesthetic technique and postoperative analgesia were standardized. Failure of treatment was defined as the occurrence of nausea and/or vomiting within the first 24 h after anaesthesia. The use of acupressure reduced the incidence of nausea or vomiting from 42% to 19% compared with placebo, with an adjusted risk ratio of 0.24 (95% CI 0.08-0.62; P = 0.005). Other variables were similar between groups.

Ambulatory or "walking" extradural analgesia in labour has recently gained popularity because of preservation of motor function and subjective somatic sensation in the lower limbs, resulting in increased maternal satisfaction. This is produced by combining dilute concentrations (e.g. 0.1%) of bupivacaine with opioids. Detailed clinical neurological examination after mobile extradural analgesia has not been reported. We have investigated the effect of 0.1% bupivacaine 15 ml and fentanyl 2 micrograms ml-1 on motor and sensory function in the lower limbs in 50 primigravidae requesting extradural analgesia in labour. This was performed before and 30 min after confirming placement of a lumbar extradural catheter. While power, co-ordination and reflexes in all lower limb muscle groups remained within normal limits, 66% (n = 33) developed abnormal distal proprioception, 44% (n = 22) had a positive Romberg's sign and 38% (n = 19) had altered vibration sense. Moreover, 44% (n = 22) said that their legs felt different on standing and they did not feel confident walking unaccompanied. However, this subjective perception correlated poorly with the presence of posterior column sensory signs. Although there was a reduction in pain scores on a visual analogue scale after 30 min (mean 8.85 (SEM 0.3) vs 3.06 (0.32); P < 0.0001), pain increased within 60 min (5.77 (0.45); P < 0.001).