Alastair A. Spence

ANÆSTHETIC PRACTICE AND PREGNANCY: Controlled Survey of Women Anæsthetists in the United Kingdom

Abstract Obstetric histories from 563 married women anaesthetists and 828 women doctor control subjects were analysed for the frequency of congenital abnormality, spontaneous abortion, and involuntary infertility. Anaesthetists working during pregnancy had a significantly higher frequency of congenital abnormality (6·5%) than those not at work (2·5%) but not significantly different from the control frequency (4·9%). They had a frequency of spontaneous abortions (18·2%) which was significantly higher than in the control group but not significantly different from anaesthetists not at work. Involuntary infertility among anaesthetists (12%) was twice as frequent as in the control group.

Dose requirements of ICI 35,868 (Propofol, ‘Diprivan’) in a new formulation for induction of anaesthesia

In order to avoid Cremophor‐related reactions and reduce the incidence of pain on injection, di‐isopropylphenol (ICI 35,868; propofol) has been reformulated as an emulsion. One hundred and fifteen patients received an induction dose of propofol in the new formulation. The dose required to induce anaesthesia in 95% of healthy, unpremedicated patients was 2.5 mg/kg. Induction was associated with a degree of cardiovascular and respiratory depression. There were no adverse reactions although there were a number of minor side‐effects. The incidence of pain on injection was low (3%) and the overall quality of induction was assessed as good or adequate in 92% of patients.

Observations on intragastric pressure

Regurgitation of stomach contents, as distinct from vomiting, is the result of a sufficiently high intragastric pressure overcoming the competence of the cardia. In the last fifteen years there have been several studies designed to demonstrate the nature of the cardiac sphincter and to evaluate the pressure required to cause retrograde flow through it13zp 3,4. By contrast, there has been much less consideration given to values for intragastric pressure. Our interest in this matter stemmed from anxiety for the pregnant woman with a breech presentation, already in the lithotomy position, requiring general anaesthesia for delivery of the after-coming head. It seemed that the combination of an intra-abdominal mass together with positioning which would raise the mass higher in the abdominal cavity might be expected to raise intragastric pressure above the non-pregnant value. We have set out to determine the magnitude and significance of the increase.

Concurrent drug therapy in patients undergoing surgery

In a retrospective study of 57 176 patients and a prospective study of 216 patients undergoing surgery, 24–32% of patients were receiving some concurrent medication. Between 10 and 16% were taking drugs for cardiovascular disease. Of these, only 71% had their normal medication prescribed before surgery and only 41% received their drugs on the day of surgery.

Pain after surgery

Pain After Surgery offers an in-depth, comprehensive overview of basic and clinical research in the field. It presents the current knowledge and expertise of top global researchers on changes in central nervous system function accompanying and following surgery, as a model of chronic pain development. It also translates scientific understanding into effective clinical management of acute and persistent pain after surgery, including preoperative interventions to decrease the risk of chronification of postsurgical pain.

Computer‐based anaesthetic records

Other uses Dr L. E. Carrie (Anaesthesia 1982; 37: 745-7) is to be congratulated on his simple design for a disposable idatabk anaesthetic wedge which can be used to replace thc lateral tilt at Caesarean section as well as the sandbag at many operations. The idatable wedge can also be used during obstetric epidurals when one is p l d under each side of tbc patient. Ooeisintlatatastheother is deflated alternately to ensure bilateral spread of the analgesic whik a l a t d tilt is maintained. Essex County Hospital, Colchester C03 3NG. F.F. C ~ L E

Postoperative pulmonary function. A comparison of ventilation with nitrogen or nitrous oxide during anaesthesia.

Arterial blood-gases and lung volumes were measured in 48 patients before and after upper abdominal surgery. There was no significant difference between the results of 25 patients ventilated with oxygen and nitrogen during anaesthesia compared with a comparable group which received oxygen and nitrous oxide.

Nitrous Oxide and Wound Healing

Following a paravertebral surgical incision, mature, female rats under ether anaesthesia were exposed to either 3% nitrous oxide, continuously for 48 h, or 50% nitrous oxide, 4 h each day for 7 days. For each exposure group, a similar number of rats was exposed to atmospheres containing no nitrous oxide. Wound healing was assessed by measurement of the breaking strengths of wound samples. No statistically significant influence on breaking strength could be attributed to nitrous oxide following either exposure sequence.

THE EFFECT OF UPPER ABDOMINAL SURGERY ON THE RELATIONSHIP OF AIRWAY CLOSING POINT TO END TIDAL POSITION

1. The relationship between end tidal position (ETP) and the point of lung emptying at which there is significant airways closure (CP) has been investigated before and after upper abdominal surgery in thirty-one patients. 2. A significant negative correlation between the index (ETP-CP) and the alveolar-arterial Po, difference (A-aDo,) was found. 3. Nineteen of these patients had a vagotomy and drainage operation and, in this group, there was a greater fall in ETP than in CP in the first and second postoperative days. 4. It is suggested that airway closure is a contributory factor to the known hypoxaemia following abdominal surgery.