SummaryThis study was performed to investigate the incidence of remifentanil-induced cough and evaluate the efficacy of lidocaine on its prevention. Five-hundred patients, aged 18-70 years, were randomly allocated into two groups to receive either lidocaine 0.5 mg.kg )1 or 0.9% normal saline intravenously 1 min before remifentanil administration at a target effect-site concentration of 4 ng.ml )1 .

Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome. Accepted for publication 8 May 2004Key words: Brugada syndrome; complications; electrocardiography; sudden death.# Acta Anaesthesiologica Scandinavica 48 (2004) I N 1992 a new syndrome was described consisting of syncope or sudden death in patients with a structurally normal heart and an electrocardiogram (ECG) characteristic of right bundle branch block with ST segment elevation in leads V 1 to V 3 . This condition was named 'Brugada syndrome' (1). The syndrome is genetically determined and caused by mutations in the gene SCN5A on chromosome 3, encoding the human cardiac sodium channel (2).There are few reports of anaesthetic management of patients with Brugada syndrome, and especially regional anaesthesia of patients with Brugada syndrome. Therefore, we report one case of regional anaesthesia and one case of general anaesthesia in patients with Brugada syndrome. Case report Case 1A 33-year-old man was presented for an emergency orthopaedic operation due to open fracture of the patella. One year ago, before admission, Brugada syndrome was diagnosed in routine cardiologic evaluation. He had no past history of syncope and there was no family history of sudden death. On admission, a physical examination revealed no abnormal findings except ECG findings showing the coved-type ST segment elevation in leads V 1 to V 3 with a right bundle branch block (Fig. 1). Echocardiography showed a normal heart with an ejection fraction of 60%. Electrophysiology study revealed normal sinus node function, but non-sustained ventricular tachycardia was induced by electric ventricular stimulation.Having been informed of the associated risks, the patient was taken to the operating room and routine monitors were applied. A radial arterial cannula was inserted under local anaesthetic. Prior to the induction of anaesthesia, an external defibrillator was prepared. Spinal tapping was carried out at the L4/5 space in right lateral position. Afterwards, 0.5% bupivacaine hydrochloride 10 mg was injected intrathecally and satisfactory spinal block was achieved up to the T 10 dermatome.During the operation, ECG and continuous blood pressure were monitored and showed no abnormalities.After a 2-h operation, the patient was transferred to the post anaesthetic care unit (PACU) and postoperative pain was controlled with intravenous patientcontrolled analgesia (PCA) using opioids and NSAID. Postoperative recovery was uneventful. Case 2A 56-year-old male with L 1 vertebral body compression fracture scheduled for spine fusion under general anaesthesia. His preoperative 12-lead ECG showed a complete right bundle branch block and ST segment elevation (Fig. 2). There was no family history of sudden death. Several years ago, before admission, he had one history of syncope attack. Echocardiogram showed no s...

Systemic venous air embolism is a serious complication in patients with chronic liver disease having liver surgery. Intrapulmonary arteriovenous shunting can permit air emboli to pass into the systemic circulation. We describe a case of paradoxical air embolism detected by transoesophageal echocardiography in a patient with cirrhosis who was having a hepatic resection.

We demonstrated that isoflurane post-conditions the heart in young but not in senescent rats. Failure to activate RISK pathway may contribute to attenuation of isoflurane-induced post-conditioning effect in senescent rats.

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