Sedation and regional anaesthesia in the adult patient

This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. Methods of assessing the level of sedation are discussed with emphasis on clinical measures. The pharmacology of the drugs involved in sedation is discussed, with propofol and remifentanil appearing to be the combination of choice for sedation in regional anaesthesia. The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferre

GRAND MAL SEIZURE AFTER EXTRADURAL MORPHINE ANALGESIA

SUMMARY Following an elective Caesarean section under extradural anaesthesia, a 30-yr-old known epileptic woman (gravida 4, para 3) developed a tonic-clonic seizure, 6 h after the administration of morphine 3 mg into the extradural space. Possible aetiological factors are discusse

Propofol 1% versus propofol 2% in children undergoing minor ENT surgery

Background. The induction characteristics of propofol 1% and 2% were compared in children undergoing ENT surgery, in a prospective, randomized, double‐blind study. Methods. One hundred and eight children received propofol 1% (n=55) or 2% (n=53) for induction and maintenance of anaesthesia. For induction, propofol 4mgkg-1 was injected at a constant rate (1200mlh-1), supplemented with alfentanil. Intubating conditions without the use of a neuromuscular blocking agent were scored. Results. Pain on injection occurred in 9% and 21% of patients after propofol 1% and 2%, respectively (P=0.09). Loss of consciousness was more rapid with propofol 2% compared with propofol 1% (47s vs 54s; P=0.02). Spontaneous movements during induction occurred in 22% and 34% (P=0.18), and intubating conditions were satisfactory in 87% and 96% (P=0.19) of children receiving propofol 1% or 2%, respectively. There were no differences between the two groups in respect of haemodynamic changes or adverse events. Conclusions. For the end‐points tested, propofol 1% and propofol 2% are similar for induction of anaesthesia in children undergoing minor ENT surgery. Br J Anaesth 2003: 90: 375-

SPONTANEOUS EXCITATORY MOVEMENTS DURINF RECOVERY FROM PROPOFOL ANAESTHESIA IN AN INFANT: EEG EVALUATION

Spontaneous excitatory movements have been observed during reco very from propofol anaesthesia in children. Epilepsy has been postulated as a possible mechanism to explain these movements. We report the first case in which these spontaneous excitatory movements were studied using simultaneous multichannel EEG recordings. (Br. J. Anaesth. 1993; 70: 459-461