The antiemetic action of stimulation of the P6 (Neiguan) acupuncture (ACP) point has been studied in women, premedicated with nalbuphine 10 mg, undergoing minor gynaecological operations under methohexitone-nitrous oxide-oxygen anaesthesia. Invasive ACP--manual or electrical at 10 Hz--applied for 5 min at the time of administration of the premedication markedly reduced the incidence of vomiting and nausea in the first 6 h after operation, compared with untreated controls. This did not occur with stimulation of a "dummy" ACP point outside the recognized ACP meridians. Non-invasive methods (stimulation via a conducting stud or by pressure) were equally as effective as invasive ACP during the early postoperative period. However, both these non-invasive approaches were less effective than invasive ACP in the 1-6 h postoperative period, although each was as effective as two standard antiemetics (cyclizine 50 mg, metoclopramide 10 mg). In view of the total absence of any side effects in more than 500 ACP procedures, the clinical applications of this finding are worthy of further study.

In a multi-facet study we evaluated the efficacy of P6 electroacupuncture (10 Hz applied for 5 min) as an antiemetic in patients receiving a variety of cancer chemotherapy drugs. The study involved 130 (15 in an open pilot study, 10 in a randomized placebo controlled crossover study and 105 in a definitive study) patients who had a history of distressing sickness after previous treatment, and who, on the basis of a previous survey, would be expected to have a 96% chance of this with subsequent therapy. Sickness was either completely absent or reduced considerably in 97% of patients and no side effects were encountered. The limited crossover study, using a ‘dummy’ acupuncture (ACP) point showed that the beneficial effects were limited to the P6 point. Logistic and ethical considerations excluded the possibility of carrying out a larger placebo-controlled study. While in our hands P6 ACP was an effective antiemetic in patients having cancer chemotherapy, because of the time involved and the brevity of the action (8 h) an alternative approach to electro-ACP is required before this technique is adopted clinically.

SummaryWe report the changes observed in a number of' pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow,.forced expiratory volume in one second,,forced tlitul capacity, ,forced expiratory volume in one second to ,forced vital capacity ratio and the maximal mid-expiratory flow. SigniJicant changes occurred that are consistent with a restrictive ventilatory defect. These changes persisted for ,four hours arfrer the induction of spinal anaesthesia. Administration of 35% oxygen by facemask ,failed to change significantly fetal umbilical vein pH or partial pressure of oxygen. Key wordsAnaesthesia; obstetric. Anaesthetic techniques regional; spinal.Spinal anaesthesia is an increasingly popular technique for elective Caesarean section [I]. An intra-operative deterioration in pulmonary function tests occurs as a result of the motor block which accompanies the sensory block of spinal anaesthesia [2]. Despite these respiratory changes and the knowledge that the partial pressure of oxygen in fetal arterial (UaPo,) and venous umbilical blood (UvPo,) increase in proportion to the maternal inspired oxygen concentration and maternal arterial oxygen partial pressure ( M P ao2) during Caesarean section under general anaesthesia and epidural anaesthesia, little attention has been directed towards the need for supplementary oxygen during Caesarean section under spinal anaesthesia [3,4].This study was designed to measure the changes in pulmonary function during spinal anaesthesia for Caesarean section and the recovery period and to determine if any difference in fetal oxygen delivery was made by the administration to the mother of 35% oxygen by mask. MethodsQueen's University Ethics Committee approval was obtained prior to commencement of the study and all patients gave written, informed consent. Thirty-six patients presenting for elective Caesarean section were invited to participate as volunteers. Patients with respiratory disease, weighing more than 100 kg, of a height of less than 1.52 m. of less than 37 weeks' gestation or having a history of fetal compromise were not studied.At the pre-operative visit the use of the Vitalograph Alpha was explained. The Vitalograph Alpha is a pneumotachograph-based spirometer capable of determining forced vital capacity (FVC), forced expiratory volume in one second (FEV,), peak expiratory flow (PEF) and the forced expiratory flow in the mid region of the forced vital capacity, i.e. the flow between 25 and 75% of expired volume (FEF25 75). The FEFx 7s is also known as the maximal mid-expiratory flow rate. Reference values were derived from nomograms based on height, weight and race. As patient effort is an important component of the accuracy of results, the best of three values was taken for each measurement [5]. Readings were taken in the sitting and left lateral position to mimic the patient's position during surgery and the pre-operative left lateral position was subsequently used as a control val...

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This report analyzes the effect of air versus ground interhospital transport on survival following multisystem injury. There were 136 air-transported patients versus 194 ground-transported patients. The groups were similar in trauma scores, ages, mechanism of injury, and organ systems injured. There was a statistically significant survival advantage for air-transported patients with trauma scores between 10 and 5 (82.8% survival vs. 53.5%, p = less than 0.001). The time interval between accident and admission to the authors' institution was similar for both groups. Important therapeutic interventions contributing to better survival by the air-transported group included higher incidences of endotracheal intubation (50% vs. 25%), blood transfusions (32% vs. 10%), larger volumes of electrolyte fluid (3.3 L per patient vs. 2.1 L per patient) as well as the use of MAST trousers (60.3% vs. 34.9%). Transport charges for both ground and air services were similar. However, helicopter charges met only 15% of the operational budget of the aeromedical service. The remainder of the costs were generated from hospital patient revenues. Overall, total hospital charges were similar for both groups and were influenced by the variability of length of stay, particularly for orthopedic patients.