James G. Bovill

Efficacy of epidurally administered sufentanil versus bupivacaine during thoracic surgery : a randomised placebo-controlled double-blind study

The efficacy of thoracic epidural sufentanil 50 μg was compared with bupivacaine 0.5% with adrenaline 5 μg.ml‐1 (dose 40 mg) or saline, in 30 patients (n = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine or saline was administered epidurally after induction of anaesthesia with sufentanil 1 μg.kg‐1 and thiopentone 2–5 mg.kg‐1. Anaesthesia was maintained with nitrous oxide 66% and halothane 0.3%. Supplementary sufentanil 25 μg was given whenever the systolic arterial blood pressure increased more than 15 mmHg above the pre‐operative value, whenever heart rate exceeded 90 beat. Min‐1 in the absence of hypovolaemia, or when other autonomic or somatic signs occurred. Fewer patients in the epidural sufentanil (n = 4, p < 0.005) and bupivacaine (n = 1, p < 0.001) groups required supplementary sufentanil compared to the placebo group, in which all patients needed supplementary sufentanil, but there was no statistical difference between the sufentanil and bupivacaine groups. One or more hypotensive episodes occurred in five patients in the sufentanil group, in all patients in the bupivacaine group and in no patient in the placebo group, and the differences were significant (p < 0.02).

New delivery systems for anaesthetics

Economic factors and ecological concerns are likely to ensure that the use of minimal-flow or fully closed-circuit anaesthesia delivery systems will become more common in the future. There are still concerns about the possible risk with sevoflurane, but these may be more theoretical than real. The u