These findings demonstrate that, in a meaningful proportion of otherwise treatment-resistant patients, clinically important improvements in pain, sleep quality and SGIC of the severity of their condition are obtained with THC/CBD spray. THC/CBD spray was well tolerated and no new safety concerns were identified.

Peripheral neuropathic pain (PNP) poses a significant clinical challenge. The long-term efficacy of delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray was investigated in this 38-week open-label extension study. In total, 380 patients with PNP associated with diabetes or allodynia entered this study from two parent randomised, controlled trials. Patients received THC/CBD spray for a further 38 weeks in addition to their current analgesic therapy. Neuropathic pain severity was the primary efficacy measure using a pain 0-10 numerical rating scale (NRS). Additional efficacy, safety and tolerability outcomes were also investigated. In total, 234 patients completed the study (62 %). The pain NRS showed a decrease in score over time in patients from a mean of 6.9 points (baseline in the parent studies) to a mean of 4.2 points (end of open-label follow-up). The proportion of patients who reported at least a clinically relevant 30 % improvement in pain continued to increase with time (up to 9 months); at least half of all patients reported a 30 % improvement at all time points. Improvements were observed for all secondary efficacy outcomes, including sleep quality 0-10 NRS scores, neuropathic pain scale scores, subject global impression of change and EQ-5D questionnaire scores. THC/CBD spray was well tolerated for the study duration and patients did not seek to increase their dose with time, with no new safety concerns arising from long-term use. In this previously difficult to manage patient population, THC/CBD spray was beneficial for the majority of patients with PNP associated with diabetes or allodynia.

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four groups on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre+ menstrum) , early follicular phase (P d 8-12), ovulatory phase

This study was designed to compare the ease of performing laryngoscopy and endotracheal intubation without muscle relaxants after the induction of anaesthesia with either thiopentone or propofol in 106 patients scheduled for elective surgery. Thiopentone (5 mg/kg) or propofol (2.5 mg/kg), supplemented with lidocaine (1.5 mg/kg) and alfentanil (30 micrograms/kg), were used in random order for the induction of anaesthesia. Jaw tone, visualisation of the larynx, position of vocal cords, ease of intubation and tolerance of the tracheal tube were assessed. The jaw was relaxed and the vocal cords were immobile/open in most patients in both groups. Visualisation of the larynx was good in 60 and 46% and intubation was easy in 48 and 22% of the patients given thiopentone and propofol, respectively (P less than 0.05 between groups for intubation). After induction of anaesthesia with thiopentone or propofol, endotracheal intubation is not recommended without the use of muscle relaxants.

The effect of three different anaesthetic techniques on the incidence and severity of postoperative emesis (nausea, retching and vomiting) We have conducted a series of studies in an attempt to decrease the incidence of postoperative nausea and vomiting but without complete success. 1-3 It has been suggested that the administration of nitrous oxide is associated with a high incidence of nausea and vomiting. 4 In our previous study, s we did not find any decrease in postoperative emesis when nitrous oxide was omitted in patients undergoing gynaecological laparotomy under isoflurane anaesthesia. Because the literature 6-7 regard- Key words MethodsOne hundred and fifty patients scheduled for elective gynaecological inpatient laparoscopy were entered into the study. The study protocol was accepted by the institutional ethics committee and informed consent for the study was obtained from each patient. Only patients in ASA physical status 1 or I1 were studied. The type of anaesthesia had been predetermined by the date of birth (day) to receive one of the three techniques. The person evaluating emesis was not aware of the method of anaesthesia used.The patients were premedicated with oxycodone chloride 0.13 mg.kg -1 IM 40-60 min before anaesthesia. After the insertion of an IV cannula and the start of an IV infusion (lactated Ringer's solution), 0.8 nag of vecuronium, 0.2 mg of glycopyrrolate and 0.1 mg of fentanyl were administered. Two minutes later anaesthesia was induced with 4 mg.kg 1 of thiopentone. Oral intubation was facilitated with 1.5 mg.kg -t of succinylcholine and anaesthesia was maintained with isoflurane in nitrous oxide and oxygen (30 per cent), enflurane with nitrous oxide and oxygen (30 per cent) or isoflurane in air and oxygen (30 per cent) administered in semi-open or semi-closed system. The initial inspired concentration of isoflurane was one per cent for those given nitrous oxide and 1.5 per cent for those not given nitrous oxide. The initial inspired concentration of enflurane was 1.2 per cent. Thereafter gases were administered according to clinical needs, the concentration being changed if, during surgery, the systolic blood pressure or heart rate changed more than 25 per cent from baseline. Inspired and end-tidal concentrations of isoflurane and enflurane were measured with an anaesthetic agent monitor and average CAN J ANAESTH 1989 / 36:2 / pp 145-8