Epidural analgesia for pain relief during labour has certain disadvantages including slow onset. However, intrathecal sufentanil provides rapid onset and well-controlled analgesia lasting 1–4 h. The aim of this study was to compare the analgesia and the side effects of intrathecal sufentanil with epidural bupivacaine during labour. In a randomized, double-blind and controlled trial 58 parturient women requesting analgesia during labour were studied. The patients received either intrathecal sufentanil 10 μg and epidural saline, or intrathecal saline and epidural bupivacaine 20 mg. Visual analogue scores (VAS) for pain, blood pressure, heart rate, respiratory rate, level of sedation and the incidence of pruritus and nausea were recorded. Pain scores were significantly lower between 5 and 90 min after injection in patients receiving intrathecal sufentanil. Pruritus was significantly more frequent among those receiving intrathecal sufentanil. The rapid onset and effective analgesia of intrathecal sufentanil may in certain situations be advantageous.

Factors affecting flow through blood administration sets in vitro were assessed under gravity-fed and pressurized conditions including an assessment of the influence of the intravenous (i.v.) cannula and Luer lock fitting. The fastest gravity-fed flow of 4.775 mL s−1 was obtained through the largest internal diameter (ID = 4.8mm) blood administration set. Flow through blood administration sets with ID = 3mm was 50% of this. Flow increased over base-line through all the administration sets when the i.v. cannula was removed (range 18–50%) and increased further over base-line when the Luer lock fitting was removed from the distal end (range 26–129%), indicating that these are rate-limiting steps in the system. The Y-type trauma set with the largest diameter tubing facilitated the fastest flow, although flow through all the Y-type trauma sets produced lower flow rates than the corresponding blood administration sets, which may reflect their relative increased length. The ideal blood administration set should have an internal diameter at least 4mm and be less than 170 cm in length.

Calcium-channel blockers reduce the in vitro effects of hypothermia and benzodiazepines have been reported to reduce inward calcium flow through L-type cardiac-calcium channels. Thus, this study was designed to determine if diazepam could reduce hypothermia-induced changes in ventricular papillary muscle electromechanical activity. Conventional microelectrode techniques were used while force was recorded using a miniature force transducer. Six experimental groups of electrically paced papillary muscles were formed (n=6 per group). One was exposed to one μm nisoldipine and four were exposed to one of four diazepam concentrations (0.1, 1.0, 10 or 100 μm). A final group had no drug and provided a time-matched control. The effects were determined at 37°C and then at 27°C. At 37°C, diazepam initially increased and then reduced inotropy and APD90. Nisoldipine reduced both APD90 and inotropy. At 27°C, 100 μm diazepam and nisoldipine (1.0 μm) reduced the hyhypothermia-induced lengthening of APD and the increase in force. Although diazepam reduced the hypothermia-induced alterations, the concentration required to do so (100 μm) suggests that this effect has little role in clinical use.

The analgesic efficacy of tenoxicam, a newer injectable non-steroidal anti-inflammatory drug, for post-operative analgesia after abdominal or orthopaedic surgery in ASA Grade I/II patients is reported. Two hundred and fifty-six patients received a single dose of tenoxicam 40 mg intravenous (i.v.) at the end of surgery and this was repeated 24 h later. These patients were compared, with respect to pain or adverse events, with 258 patients that received placebo. All patients were monitored for the next 72 h. Overall, tenoxicam provided reliable analgesia with comparable pain scores at rest, moving and coughing. The cumulative rescue PCA-morphine consumption was always lower in the tenoxicam treated patients and was most marked at 4 and 24 h after the second injection of tenoxicam. This effect was more pronounced after abdominal surgery. The intravenous administration of tenoxicam was associated with a low incidence of adverse events and a high tolerability.

The aim of the present study was to investigate the effect of intravenously (i.v.) administered fentanyl and clonidine on ventilation in 12 healthy male volunteers (age 30.8±4.9 years) who either received fentanyl alone (1.5≥μg kg−1) or fentanyl (1.5≥μg kg−1) in combination with clonidine (3≥μg kg−1). The effect on ventilation was measured with a CO2 rebreathing system. The respiratory depression caused by fentanyl disappeared 120 min after injection. The corresponding slopes were 7430±2075 mL kPa−1 prior to (t0) and 6263±1864 mL kPa−1 120 min post-application (base-line vs. t120; P=0.106). An impaired ventilatory response was observed during CO2 rebreathing at t120 after the injection of fentanyl and clonidine. Before drug administration, the slope of the response curves was 7700±2800 mL kPa−1, which was reduced to 5480±2135 mL kPa−1 (P<0.035) at t120. These data suggest a prolongation of a fentanyl-induced ventilatory depression when used in combination with clonidine.

Summary

Background and objective: The Doppler-derived echocardiographic TEI-index, defined as the sum of the left ventricular isovolumic contraction and isovolumic relaxation times divided by ejection time, quantifies combined systolic and diastolic ventricular functions. The index has been proposed to be independent of arterial pressure and heart rate, implying a broad clinical usefulness. However, it is unclear whether the index is preload independent. We assessed whether and to what degree the TEI-index is altered by left ventricular loading conditions, and the feasibility of measurement by transoesophageal echocardiography during anaesthesia and mechanical ventilation.

Methods: We studied 17 anaesthetized mechanically ventilated patients with coronary artery disease during variations in left ventricular preload evoked by head-up and head-down tilt, respectively.

Results: A head-down tilt increasing left ventricular end-diastolic area from 18.8 ± 4 to 23.7 ± 4 cm2 (P < 0.05) significantly decreased the TEI-index from 0.5 ± 0.17 to 0.33 ± 0.15 (P < 0.05). In contrast, the TEI-index remained unchanged with decreased left ventricular preload (14.4 ± 3.7 cm2) during head-up tilt.

Conclusions: An increase in preload decreases the TEI-index indicating its sensitivity to acute increases in left ventricular preload. The TEI-index can be measured perioperatively by transoesophageal echocardiography.

The effect of a single pre-operative oral dose of controlled release diclofenac sodium on post-operative pain after minor gynaecological surgery was investigated. Fifty-two women took part in a double-blind controlled study. Pain was assessed by visual analogue scale (VAS), a four-point verbal rating score, and the requirement for post-operative analgesia. Those patients who received diclofenac had significantly less post-operative pain than the placebo group up to 2 h after surgery.

Although nonopiate analgesics may be particularly useful in the immediate postoperative period after major surgery, their use has been associated with haemodynamic adverse effects during postoperative pain treatment and in critically ill patients in intensive care. The effect of a single intravenous dose of metamizol (dipyrone) 2g, ketorolac 30mg and propacetamol 1g on haemodynamic variables and pain control in the immediate postoperative period after heart surgery is compared. Seventy-two patients undergoing elective coronary and/or heart valve surgery, were included in a cohort study of 1-years duration (1998). After weaning from mechanical ventilation and extubation, haemodynamic variables and a 4-point verbal rating pain scale were asseseed at base-line and 60 min after the administration of a single doses of metamizol, ketorolac or propacetamol. The Student's t-test for paired samples was used to compare changes produced by the study medications. A significant, but small, decrease in radial artery blood pressure was observed in all treatment groups which had little clinical relevance; no vasodilator effects were observed and ventricular function showed only minor changes: propacetamol decreased cardiac index by 10% and a 15% decrease in right ventricular work was also observed. Metamizol and ketorolac produced a 10% decrease in the left ventricular work index. Pain scores showed a statistically significant decrease in all treatment groups. The analgesic effects of metamizol, ketorolac and propacetamol were not associated with a clinically significant impairment in haemodynamic function when administered to haemodynamically stable patients.

Background and objective The use of tension-free tape in the vagina is a relatively new surgical procedure for the treatment of urinary incontinence. Traditionally, the procedure is carried out using local anaesthesia and sedation. We aimed to assess the quality of anaesthesia obtained during insertion of tension-free vaginal tape using local anaesthetic infiltration and intravenous conscious sedation.

Methods Twenty-four patients were studied using intravenous midazolam, fentanyl and infiltration with 0.5% prilocaine and epinephrine. Visual analogue scores before operation were used to assess anxiety. The digit symbol substitution test was used before and after surgery to assess psychomotor recovery, and amnesia for the procedure was assessed by means of picture recall. A nurse, anaesthetist and surgeon independently assessed quality of anaesthesia based on vocalization, facial expression, movement and co-operation with incontinence testing.

Results The nurse, anaesthetist and surgeon reported good or excellent conditions in 18, 14 and 22 cases, respectively. There was no significant psychomotor impairment using the digit symbol substitution test, with mean (standard deviation) preoperative and postoperative scores of 22 (8) and 21 (7) correctly matched symbol digit pairs. There was a significant correlation between preoperative anxiety and intraoperative fentanyl requirement (r=0.48, P < 0.05).

Conclusion Satisfactory anaesthetic conditions can be achieved for the insertion of tension-free vaginal tape using local anaesthesia with sedation.

Nurses have become independent over the last few decades in Italy, thanks to a series of legislative changes. When dealing with organ donation, the nurses usually face unexpected and complex situations from both a technical and interpersonal point of view. When the death of a loved one has to be communicated to the family, the coordinator nurse, along with the doctor, talks with the relatives to help them decide whether or not to donate organs. It is fundamental that the death of the patient is communicated by the doctor in charge of the case and this has to be done before the question of donation is raised. The idea of donation is suggested when we believe the family has understood that their beloved is dead. We try to adapt our communication style to the background of the family. Experience has shown us that these situations are emotionally complex and tiring for both the family members and health workers. Sometimes the stress level amongst health workers is so high that psychological support is needed after the interview. If the family decides to donate, the restitution phase is very important. A meeting is organized for a month after the event to inform the relatives of the success of donation.

To compare the efficacy in the treatment of post-operative nausea and/or vomiting (PONV), 75 patients undergoing gynaecological procedures under general anaesthesia using N2O/enflurane who suffered from PONV in the first hour after surgery were randomly allocated to three groups containing 25 patients each to receive either alizapride 100 mg, droperidol 1mg or ondansetron 8mg (i.v.). Patients expressed the severity of their nausea on a Visual Analogue Scale (VAS) ranging from 0 (none) to 10 (as bad as possible). Vomiting was recorded as present or absent, and the number of emetic events was noted. Data were recorded until rescue medication was given or until 4 h after the administration of the study drug. There were no significant differences between the three groups in the average VAS scores and the presence of vomiting at the time of entry into the study. Fifteen and 30 min after the administration of the study drug, VAS decreased notably in all groups. This decrease was similar and statistically significant within each group. However, comparison between the three groups showed no statistically significant differences. There was no statistically significant difference between the three groups in the number of patients receiving rescue medication, the number of emetic events and the time from administration of the study drug until rescue medication was given. It is concluded that alizapride 100 mg, droperidol 1mg and ondansetron 8mg intravenously are equally effective in the treatment of PONV after gynaecological procedures and that the newer drugs alizapride and ondansetron offer no advantage over droperidol.