The anaesthetic management of a patient with tuberous sclerosis undergoing two-stage scoliosis surgery is described. The patient suffered from severe mental retardation, seizures and facial angiofibromas. General anaesthesia using isoflurane and nitrous oxide in oxygen, supplemented with opioid analgesia and hydralazine, and labetalol to induce hypotension, appeared to be satisfactory. Postoperative recovery was delayed and complicated by pleural effusion, sputum retention and mild seizures. Tuberous sclerosis is an autosomal dominant disease well known for its neurocutaneous manifestations. Other organs such as the heart, lungs and kidneys may be involved. The potential problems in the anaesthetic management of a patient with tuberous sclerosis are discussed.

The processes of anaesthesia and surgery attenuate normal homeostatic thermoregulation and impose large thermal stresses. The resulting changes in body temperature may be detrimental and it is important, therefore, that anaesthetists understand normal thermoregulation and the ways in which this process may be affected by anaesthesia.

SummaryThree regimens for rewarming patients after cardiac surgery involving hypothermic cardiopulmonary bypass were studied in 30 patients. The control group (n = 10) received no active rewarming, the oesophageal group (n = 10) was warmed centrally using an oesophageal heat exchanger and the radiant group (n = 10) was warmedperipherally with an overhead radiant heater. There were no statistically SignEficant diFerences between the groups apart from the higher mean skin temperatures in the peripheral group. Key wordsTemperature; body. Surgery; cardiovascular. Equipment.A device for noninvasive central rewarming of hypothermic patients by recirculation of warm water through an oesophageal tube has recently become available (The Exacon thermal therapy system) and was effective in experimental hypothermia in dogs,' accidental hypothermia in humans2 and in prevention of peroperative hypothermia.' There have been no studies using this technique after cardiopulmonary bypass procedures; however, peripheral warming using a radiant overhead heater was demonstrated to be effective in this situation."h This study was designed to compare the efficacy of central oesophageal rewarming with peripheral rewarming using a radiant overhead heater (the Aragona mobile thermal ceiling) after cardiac surgery. MethodsThirty patients after routine coronary artery bypass grafting were randomly allocated to one of three groups: a control group, no active rewarming in the postoperative period; an oesophageal group, rewarming using the Exacon TT8200 thermal therapy system. This consists of a disposable double lumen oesophageal tube and a base unit comprising water heater, circulating pump and monitor/ alarm module. Sterile distilled water is circulated through the oesophageal tube at a rate of 3 litres/minute. The temperature of the circulating water is variable and in this study the maximum temperature of 42°C was used. The oesophageal tube was inserted in theatre after heparinisation had been reversed; a radiant group, rewarming using the Aragona mobile thermal ceiling. The heating surface was mounted approximately 1 m above the patients and the output adjusted initially to maximum but then decreased to maintain skin temperature at 37°C. The patients were treated identically in all other respects.Anaesthesia consisted of premedication with papaveretum, hyoscine and droperidol given 1-2 hours pre-operatively and induction with a sleep dose of thiopentone and fentanyl (50 pg/kg). Neuromuscular blockade was achieved using pancuronium (0.15 mg/kg) and anaesthesia was maintained with 50% nitrous oxide in oxygen; muscle relaxation was not reversed at the end of surgery. Bypass temperatures of 27-28°C were used for all patients. Temperature monitoring probes were attached on arrival in the intensive care unit (ICU) and allowed to stabilise for 15 minutes before the readings started. Intermittent positive pressure ventilation was continued after operation with oxygen-enriched air. Humidification of inspired gases was achieved using the Engstrom E...

The aim of the study was to describe the endoscopic-assisted epiphysiodesis technique and review our 20-year experience with it. A retrospective review of 44 patients who underwent proximal tibia and/or distal femur endoscopic-assisted epiphysiodesis was carried out. Only patients who had preoperative and postoperative scanograms with clinical follow-up of at least 6 months were included. The mean length of follow-up was 36.8 months. All patients had radiographic evidence of physeal fusion within 6-12 months from the index procedure. No patient required revision surgery. Endoscopic-assisted epiphysiodesis is safe, effective, and achieves predictable physeal fusion. Advantages over current techniques include reduced radiation exposure and lack of requirement for hardware placement.