Medical practice on Tristan da Cunha--the remotest island community in the world.

Midway between Africa and South America, on the edge of the 'roaring 40s' (37°S 12°W) is an archipelago of five tiny volcanic islands. Tristan, a British Overseas Territory, is the largest--seven miles across and rising 7,000 feet above sea level. There is no airport, no air access except for an occasional ship's helicopter and no sheltered anchorage.

Comparison of the effect of two dose schedules of oral omeprazole with oral ranitidine on gastric aspirate pH and volume in patients undergoing elective surgery.

We have compared gastric aspirate pH and volume at induction of anaesthesia in 222 patients who had received either omeprazole or ranitidine before elective operations. Omeprazole was given orally either as 40 mg on the evening before and 40 mg on the morning of surgery or as 80 mg on the morning of surgery. Ranitidine 150 mg was given orally on the evening before surgery and 2 h before anaesthesia.

Does injection of non-depolarizing neuromuscular blockers before thiopentone affect their speed of onset? A study of tubocurarine and vecuronium.

In an open sequential pharmacodynamic study in 40 patients, the rate of onset of neuromuscular blockade using tubocurarine or vecuronium was measured. Comparison was made between groups of 10 patients who received thiopentone followed by either blocker and a "reverse" sequence where the blocker was injected before thiopentone. There was a small difference between groups, amounting to a few seconds in rate of onset of block, but this was not suggestive of a systematic effect of the drug sequence.

Monitoring neuromuscular blockade. The table knife transducer.

A simple and inexpensive force transducer made from a stainless steel table knife is described. Construction is straightforward and utilises strain gauges that are readily available. Amongst its attributes are lightness, ease of application, low sensitivity to postural changes and linearity over extended periods of time.

Single-shot i.v. anaesthesia for outpatient dental surgery. Comparison of 2,6 di-isopropyl phenol and methohexitone.

A single i.v. bolus dose of propofol 3 mg kg-1 was compared with methohexitone 2 mg kg-1 as the sole anaesthetic agent for simple dental extraction in outpatients.

Abdominal wound perfusion for the relief of postoperative pain.

In a double-blind trial, 50 patients with subcostal incisions performed for cholecystectomy or splenectomy, received 10 ml of either 0.5% bupivacaine plain or physiological saline twice daily by wound perfusion through an indwelling drainage tube for 3 days after operation. Analgesia, assessed by visual analogue score (VAS) and forced vital capacity (FVC), was significantly improved after perfusion with bupivacaine.

Systems modification in obstetric analgesia.

The need is identified of certain women in labour for a more potent analgesic than entonox. We describe a modification of the Entonox demand system incorporating an Oxford Miniature Vaporizer and there is a discussion directed towards its supervision.