We have assessed the incidence of pain on injection of rocuronium and evaluated if pretreatment with lidocaine i.v. reduced it, in a randomized, controlled study in 90 patients. We found that 37% of patients who received lidocaine 10 mg pretreatment had pain on injection of rocuronium compared with 77% of patients who received saline pretreatment and 7% of patients who were pretreated with lidocaine 30 mg (P < 0.05 in each instance compared with control). In addition, patients pretreated with lidocaine were less likely to suffer moderate or severe pain. Both lidocaine 10 mg and 30 mg i.v. given before administration of rocuronium significantly reduced the incidence and severity of pain on injection of rocuronium, and the higher dose was more effective.

SummarySixty A S A grade 1 unpremedicated patients scheduled for minor elective surgery were randomly allocated to receive general anaesthesia consisting of either propofol-nitrous oxide in oxygen or a conventional technique of thiopentone-isojlurane-nitrous oxide-oxygen. Baseline axillary temperature readings, duration of operation and intra-operative decrease in axillary temperature were similar in both groups. The patients who received propofol-nitrous oxide-oxygen anaesthesia had a significantly lower incidence of postanaesthetic shivering than the control group. A propofol-nitrous oxide-oxygen technique may be preferable when postanaesthetic shivering is deemed undesirable. Key wordsComplications, shivering. Anaesthetics, intravenous, propofol.Shivering is common during recovery from anaesthesia. The incidence ranges from 5% to more than 60% [l] and varies with the age and sex of patients, anaesthetic technique and the duration of operation [2-51. Whilst there is little difference in the incidence of postanaesthetic shivering amongst the commonly used volatile agents, the influence of a total intravenous technique with propofol remains undetermined. Therefore, we compared the incidence of postoperative shivering following propofol-nitrous oxide anaesthesia with a conventional isoflurane-nitrous oxide technique. MethodsAfter institutional ethics committee approval and informed patient consent were obtained, we prospectively studied 60 ASA grade 1 unpremedicated adult patients aged 18-55 years who were scheduled for elective noncavity surgery (knee arthroscopy, herniorrhaphy, removal of simpleorthopaedic implants and excision of breast lump). Patients who had a recent episode of infection or blood transfusion or were receiving regular medication were not studied.The patients were randomly divided into two groups: the first received thiopentone 5 mg.kg-' and fentanyl2 pg.kg-' on induction and were maintained with 70% nitrous oxide and 1.5% isoflurane in oxygen (thio/iso/N20 group) and the second received propofol 2 mg.kg-' and fentanyl 2 pg.kg-' on induction and then 70% nitrous oxide in oxygen and a propofol infusion for maintenance (propofol group). The continuous propofol infusion was delivered by a Terumo syringe pump with an initial rate of 10 mg.kg-'.h-', reduced by 2 mg.kg-'.h-' every 10 min until a rate of 6 mg.kg-'.h-' was reached. If the patient's pulse rate or systolic blood pressure exceeded by 30% the pre-operative baseline readings, an additional bolus of propofol 0.5 mg.kg-' was given and the infusion rate increased by 2 mg.kg-'.h-l. Continuous patient monitoring included ECG, pulse oximetry, noninvasive blood pressure and end-tidal carbon dioxide.Axillary temperature was recorded using an electronic thermometer (Terumo CIIS) prior to induction and at 15min intervals thereafter until the end of surgery. No warming mattress was used and the operating theatre temperature was maintained at 22(SD 0.5)"C and a relative humidity of 55-58%. Unwarmed intravenous fluid was infused at a rate of lOml.kg-'...

We have compared a new intubation manoeuvre using a fibreoptic bronchoscope with conventional blind placement of a double-lumen tube. Thirty adult patients who presented for thoracoscopy requiring one-lung ventilation underwent endobronchial intubation with a double-lumen tube inserted either in the conventional blind way or using a fibreoptic bronchoscope. There were four misplacements of the double-lumen tube using the conventional method but none using the bronchoscope. In addition, the bronchoscope allowed more rapid intubation (mean 106 vs 347 s). The results suggest that the fibreoptic-guided method of inserting the double-lumen tube was a satisfactory alternative to the conventional one.

Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.

A 30-year-old HIV-positive man presented with acute hydrocephalus secondary to tuberculous meningitis, for which an external ventricular drain was inserted. He developed marked natriuresis in the postoperative period, which resulted in acute hyponatraemia (131 to 122 mmol/l) and a contraction of his intravascular volume. A diagnosis of cerebral salt wasting syndrome was made, and he responded to sodium and fluid loading. This case highlights the differentiation of cerebral salt wasting syndrome from the more commonly occurring syndrome of inappropriate anti-diuretic hormone secretion as the aetiology of the hyponatraemia.