Chronic post-sternotomy pain is an important complication that may have a significant impact on the patient's everyday life. Future studies will show whether minimising complications, improving postoperative care and starting early adequate pain management will reduce the incidence of this problem.

Both ventilation modes produced epileptiform EEG. With controlled ventilation, epileptiform discharges were seen in 88% of children. This warrants further studies of the suitability of this induction type in general, and especially in children with epilepsy.

Gabapentin alleviates and/or prevents acute nociceptive and inflammatory pain both in animals and volunteers, especially when given before trauma. Gabapentin might also reduce postoperative pain. To test the hypothesis that gabapentin reduces the postoperative need for additional pain treatment (postoperative opioid sparing effect of gabapentin in humans), we gave 1200 mg of gabapentin or 15 mg of oxazepam (active placebo) 2.5 h prior to induction of anaesthesia to patients undergoing elective vaginal hysterectomy in an active placebo-controlled, double blind, randomised study. Gabapentin reduced the need for additional postoperative pain treatment (PCA boluses of 50 microg of fentanyl) by 40% during the first 20 postoperative hours. During the first 2 postoperative hours pain scores at rest and worst pain score (VAS 0-100 mm) were significantly higher in the active placebo group compared to the gabapentin-treated patients. Additionally, pretreatment with gabapentin reduced the degree of postoperative nausea and incidence of vomiting/retching possibly either due to the diminished need for postoperative pain treatment with opioids or because of an anti-emetic effect of gabapentin itself. No preoperative differences between the two groups were encountered with respect to the side effects of the premedication. However, 15 mg oxazepam was more effective in relieving preoperative anxiety than 1200 mg gabapentin.

The best method was the combination of remifentanil 4 microg kg(-1) and propofol 2.5 mg kg(-1). This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.

Sevoflurane-maintained anesthesia induced with propofol or sevoflurane in small children: induction and recovery characteristics Purpose: To compare the induction and recovery characteristics of sevoflurane anesthesia induced with either propofol or sevoflurane in pediatric outpatients. Methods: Fifty-two children, aged 1-3 yr, presenting for ambulatory adenoidectomy were randomly allocated to receive 3 mg.kg -i propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Tracheal intubation was facilitated with 0.2 mg'kg -I mivacurium. Anesthesia was maintained with nitrous oxide/oxygen (FIO 2 0.3) and sevoflurane approximately 3-5% inspired concentration with controlled ventilation. Intubation was assessed by an anesthetist blinded to the induction method. Recovery characteristics were compared using the modified Aldrete scoring system, the Pain/Discomfort scale and measuring specific recovery times. A postoperative questionnaire was used to evaluate the children's well-being at home. Results: Intubating conditions were similar in both groups. Emergence from anesthesia occurred earlier with sevoflurane for induction than with propofol (I I ___ 4 vs 17 ___ 7 min (mean +--SD), P = 0.0002). More children in the sevoflurane group achieved full points on the modified Aldrete scoring system during the fin 20 rain after anesthesia (P < 0.05). However, children in the sevoflurane group scored higher in the Pain/Discomfort scale at I 0 rain after anesthesia (P = 0.04) and were given postoperative analgesics earlier than children in the propofol group ( 13 -5 min vs 18 +-I I min, P = 0.03). The time to meet discharge criteria and recovery at home were similar. Conclusions: Induction of sevoflurane anesthesia with propofol for day-case adenoidectomy results in longer, but more calm, early recovery but does not delay discharge or affect recovery at home.Objectif : Comparer les caract&istiques de l'induction, r~alis6e avec du propofol ou du s6voflurane, et de la r&up6ration d'une anesth&ie avec du s6voflurane chez des patients ambulatoires de p~diatrie. M&hode : Cinquante-deux enfants, ~g& de I fi 3 ans, qui se sont pr&ent~s pour une ad~no'idectomie ambulatoire, ont ~t~ r~partis de fagon al6atoire et ont re~u 3 mg'kg -i de propofol iv ou de s~voflurane 8 % par inhalation pour l'induction de l'anesth&ie. ILintubation endotrach~ale a &~ facilit6e par 0,2 mg'kg -~ de mivficurium. IJanesth&ie a ~t6 maintenue avec un m~lange de protoxyde d'azote et d'oxyg~ne (FIO 2 0,3) et du s~voflurane d'une concentration approximative de 3 ~ 5 % administr~ par inhalation et accompagn~ d'une ventilation contr616e. ILintubation a ~t~ ~valu& par un anesth&iste impartial qui ne connaissait pas la m&hode d'induction. Les caract&istiques de la r&up&ation ont ~t~ compar&s en utilisant le syst~me de cotation modifi~ d'Aldrete, l'&helle Douleur/Inconfort et les mesures sp&ifiques des temps de r&up~ration. Un questionnaire postop&atoire a ~t~ utilis6 pour ~valuer le bien-&re des enfants de retour ~ la maison. 1M,s'ultats : Les con...