The efficacy of ginger for the prevention of postoperative nausea and vomiting was studied in a double-blind, randomized, controlled trial in J08 ASA 1 or 2 patients undergoing gynaecologicallaparoscopic surgery under general anaesthesia. Patients received oral placebo, ginger BP 0.5g or ginger BP l.Og, all with oral diazepam premedication, one hour prior to surgery. Patients were assessed at three hours postoperatively. The incidence of nausea and vomiting increased slightly but nonsignijicantly with increasing dose of ginger. The incidence of moderate or severe nausea was 22, 33 and 36%, while the incidence of vomiting was 17, 14 and 31% in groups receiving 0, 0.5 and 1.0g ginger, respectively (odds ratio per 0.5g ginger 1.39 for nausea and 1.55 for vomiting). These results were essentially unchanged when adjustment was made for concomitant risk factors. We conclude that ginger BP in doses of 0.5 or 1.0 gram is ineffective in reducing the incidence of postoperative nausea and vomiting.

SummaryThe arterial oxygen saturation of 40 mothers in thejrst stage of labour was monitored using pulse oximetry. Half the mothers received epidural analgesia and the rest inhaled Entonox for pain relief. Eight mothers in the Entonox group and six in the epidural group had at least one episode of signifjcant hypoxia (saturation < 90%). There was little diyerence in the number of hypoxic episodes experienced by either group (29 in the Entonox and 21 in the epidural) although their mean duration and severity was greater in the Entonox group. Women in labour who inhale Entonox have an appreciable incidence of arterial desaturation. Epidural analgesia reduces the severity of hypoxic episodes although it does not eliminate them. Key wordsAnaesthesia; obstetrics. Analgesics; Entonox. Anaesthetic techniques, regionab epidural. Hypoxia.Entonox is commonly used during labour for pain relief because of its ready availability, ease of administration and perceived safety, although opioids are often additionally required to ensure satisfactory analgesia. There is evidence that both of these methods can cause arterial desaturation. Transient hypoxic episodes have been reported when Entonox, opioids or a combination are given [l-31. Whilst the probable cause is multifactorial, hyperventilation from the pain of contractions before Entonox becomes effective is believed to be important [4]. The effect of epidural analgesia on maternal oxygenation is unknown.This study was performed to assess and compare the incidence of transient hypoxic episodes in the first stage of labour in mothers receiving either Entonox or epidural analgesia for pain relief. MethodApproval for this study was obtained from the Local Ethics Committee and informed consent was obtained. Forty healthy mothers, all with a normal medical and obstetric history, who were in the first stage of labour and had a cervical dilatation of greater than 2 cm, were studied. Mothers were allocated into two groups depending on their choice of analgesia for labour. The epidural group had an epidural sited at the L,, or L2-3 level with an analgesic level extending to the T,, level. This was maintained with an infusion of 20 m1.h-' of 0.1% plain bupivacaine, bolus injections of 0.25% bupivacaine being given if needed. During the investigation, the labouring mothers in the epidural group were pain-free.The second group received Entonox for pain relief. The mothers breathed Entonox during their contractions and a Wright's respirometer was used to measure the volume of Entonox inhaled during each contraction. No opioids were administered to either group within 4 h of the study period.Maternal arterial oxygen saturation (Spo,) was measured continuously for 25-40 min using an Ohmeda Biox 3700 pulse oximeter with an ear probe. The number of contractions occurring during this period was recorded. The same investigator (Z.A.) was present throughout to ensure that the pulse oximeter probe made good contact with the ear lobe and that it had a good quality signal. After each patient was st...

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SummaryOne size of patient-controlled analgesia demand dose does not suit all patients after surgery. We have constructed a new patient-controlled analgesia system (variable-dose patient-controlled analgesia) in which patients have a choice of demand dose sizes. In an initial trial, patients could choose between 0.5, 1.0 or 1.5mg morphine. Patients readily understood the system and were all 'satisfied' (n = 1) or 'very satisfied' (n = 9) with the system. Only two patients sought 'complete relief' from pain, most reported seeking 'moderate relief'. AN patients obtained 'a lot of relief' or 'complete relief' with this patient-controlled analgesia system. This preliminary experience suggests that variable dose patient-controlled analgesia warrants further investigation and comparison with conventional patient-controlled analgesia.