Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation.

Background: Implantation and testing of implantable defibrillators (ICDs) using local anesthetic and conscious sedation is widely practiced; however, some centers still use general anesthesia. We assessed safety and patient acceptability for implantation of defibrillators using local anesthetic and conscious sedation.

Methods: The records of 500 consecutive device implants from two UK cardiac centers implanted under local anesthetic and conscious sedation from January 1996 to December 2004 were reviewed.

Gastrointestinal stromal tumors (GIST) and laparoscopic resection.

Aim: To review management, outcome and the lessons learnt from a laparoscopic approach to GISTs.

Method: All cases of GIST presenting to the upper GI MDT between 2000 and 2006 were reviewed. Presentation, preoperative investigations, management and follow-up were recorded.

Ventricular fibrillation induced by carotid sinus massage without preceding bradycardia.

Carotid sinus massage is widely used to detect carotid sinus hypersensitivity in patients presenting with syncope. Although generally safe, the risks associated with the procedure may not be fully appreciated by either the patient or the attending medical staff. We present the case of a patient who developed ventricular fibrillation during carotid sinus massage, not explained by preceding bradycardia or concomitant predisposing heart disease, and which highlights the need for ready availability of resuscitation equipment during this procedure.

Local anaesthesia in elective inguinal hernia repair: a randomised, double-blind study comparing the efficacy of levobupivacaine with racemic bupivacaine.

Objective: To assess the use of infiltration with local anaesthetics levobupivacaine and bupivacaine, during inguinal hernia repair.

Design: Double-blind, randomised study.

Setting: Postgraduate medical school, United Kingdom.