One hundred and sixty-nine patients (aged 65-98 years) were randomised to receive either local or general anaesthesia for cataract surgery. Cognitive function was assessed using a battery of psychometric tests performed pre-operatively. and at 24 h, 2 weeks and 3 months postoperatively. Oxygen saturation, blood pressure and heart rate were monitored and the results recorded throughout the anaesthetic and immediate recovery period. In the general anaesthetic group, 19% of patients experienced at least one episode of oxygen desaturation during the procedure compared with none in the local anaesthetic group. Pulse rate and blood pressure were stable in the local anaesthetic group compared with the general anaesthetic group where marked fluctuations were noted; 61 % of patients in the general anaesthetic group experienced falls in systolic blood pressure greater than 30% of the preinduction value. No evidence of long-term postoperative cognitive dysfunction was detected and there was no signijicant digerence between the performances of the two groups. Key wordsAnaesthesia, general. Anaesthesia, local. Surgery; cataract extraction. Brain; cognition; memory.The proposition that the elderly patient is particularly susceptible to cognitive dysfunction following general anaesthesia was first advanced by Bedford in 1955 [I]. Subsequent studies [2-121 have failed to dispel this fear and the putative risk of long-term cognitive impairment following general anaesthesia in the elderly was re-iterated in a recent editorial [13].Although there is a growing interest in the use of local anaesthesia (LA) for cataract surgery, the majority of such operations in the United Kingdom are still performed under general anaesthesia (GA). The relative merits of these two techniques have been discussed recently [14], but few studies have attempted a prospective, controlled evaluation. In particular, the effects on cognitive and functional competence following each technique have yet to be fully resolved. This prospective study was undertaken to evaluate differential changes in cognitive function after LA or GA for cataract extraction in elderly patients and to establish whether episodes of hypotension or hypoxia during anaesthesia had any influence on outcome. MethodAfter institutional ethics committee approval had been obtained, we studied 169 patients, aged greater than 65 years, scheduled for elective cataract extraction; all gave informed consent. Patients were not studied if any of the following criteria were fulfilled: (a) surgical contraindication to LA, (b) inability to communicate due to severe deafness or poor command of English, (c) uncontrolled hypertension (diastolic blood pressure > 1 15 mmHg), (d) myocardial infarction within the previous 6 months, (e) uncontrolled heart failure, (f) severe respiratory disease, (g) acute neurological or psychiatric illness. Patients either had their surgery as inpatients or were treated on an outpatient basis. Patients in each category were randomised separately to receive either local anaest...

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The argon fluoride excimer laser emits radiation in the far ultraviolet part of the electromagnetic spectrum (193 nm

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In the two weeks immediately after the Bhopal disaster a community based survey was carried out in a series of eight exposed and two non-exposed clusters of households. The primary concern was the effect of the gas (subsequently identified as methyl isocyanate) on the eyes of the victims but data were also sought on respiratory status and the first symptoms of the exposure. No case of blindness was encountered that could be attributed to the gas. The most frequent symptoms reported were burning of the eyes, coughing, watering of the eyes, and vomiting. Among these, the frequency of cough most closely followed the rate of death in the different clusters. Although much rarer overall, the frequency of reported diarrhoea appeared to bear a stronger relation to death rates. Reports of photophobia and the clinical finding of superficial interpalpebral erosion of the cornea were more frequent where the death rates were lower. This clinical and epidemiological picture is consistent with different effects of the gas at different doses (as estimated from distance from the factory).