No abstract

Actively warming patients during surgery is considered the best method of preventing inadvertent hypothermia. In order to investigate the effect of forced air warming on postoperative oxygen consumption, we studied 26 patients undergoing orthopaedic surgery using a prospective, randomized trial design. We measured oxygen consumption, carbon dioxide production, temperature, thermal comfort and pain scores. Apart from intraoperative temperature, there were no significant differences in these measurements between the two groups. This study demonstrated the gradual heat gain and also the potential for hyperthermia from pre-and intraoperative forced air warming. We conclude that forced air warming is not necessary for moderate duration non-body-cavity surgery if effective preinduction covering of patients and minimal surgical exposure is achieved.

Amethocaine has recently been introduced as a topical local anaesthetic preparation. Following sporadic reports of severe local adverse effects, we conducted an audit of 372 children attending our hospital for day surgery. We conclude that 4% amethocaine cream is a safe and effective topical anaesthetic and that the incidence of severe local adverse reactions is rare. We also report two of these local reactions, one involving occupational exposure.

This review examines the pathophysiology of isolated systolic hypertension, changing medical perspectives on this condition as a cardiovascular risk factor in the community and evolving evidence of it being an independent risk factor for perioperative morbidity and mortality.Hypertension is regarded as an added risk in anaesthesia. Continuation of antihypertensive medication through the perioperative period is an established principle. Studies supporting this practice have demonstrated greater perioperative haemodynamic stability in association with general anaesthesia and surgery in patients with treated hypertension compared to untreated hypertension. Therapy has historically focused on control of diastolic blood pressure, rather than systolic blood pressure. Recent clinical trial data and data from large observational studies show a closer association of systolic hypertension with both coronary heart disease and stroke compared with diastolic hypertension. This has led to recommendations for aggressive treatment of isolated systolic hypertension, especially in patients over 65 years old.The association between decreased compliance of the central systemic arteries and isolated systolic hypertension is well understood. The fact that this same pathology, lack of compliance of central arteries, can cause a decrease in diastolic blood pressure is not so well recognised. This means that, in patients with isolated systolic hypertension, decreasing diastolic blood pressure can be associated with worsening arterial disease and that systolic minus diastolic blood pressure may give a better indication of the problem.Anaesthetic assessment and technique should be studied and potentially revised in the light of these changes in perspective on isolated systolic hypertension.

The effectiveness of fentanyl and ketorolac in providing analgesia for day-case gynaecological procedures was evaluated in 55 healthy volunteers in a single blinded fashion. Fentanyl (1 mcg/kg iv) and ketorolac (30 mg im) were administered immediately following induction of anaesthesia. Anaesthesia was standardized with propofol, nitrous oxide and enflurane. Outcome variables assessed were pain, additional analgesic requirements, and incidence of postoperative nausea and vomiting. All variables were recorded at 15 minutes, 2 hours and 24 hours postoperatively. There was no significant difference between the 2 groups with respect to any of the measured variables. Both drugs were ineffective as sole analgesic agents in half of their respective groups. It may be that a combination of these drugs, providing a multireceptor approach to analgesia, will prove to be more effective.