Remifentanil in combination with propofol for spontaneous ventilation anaesthesia.

We have investigated the effect of four doses of remifentanil on the incidence of respiratory depression and somatic response at incision. Remifentanil was administered as a loading dose of 0.125, 0.

Anaesthesia for day-case surgery.

With the current expansion of day surgery, many patients scheduled for elective surgery in British hospitals will receive their treatment on a day basis. Day-case anaesthesia exerts a profound effect on the success and feasibility of day-case surgery. Inpatient anaesthetic techniques are not always the most suitable in this area where even minor morbidity is important.

Day case laparoscopy. A comparison of two anaesthetic techniques using the laryngeal mask during spontaneous breathing.

Forty women undergoing day case laparoscopy were randomly allocated to receive either an inhalational or total intravenous anaesthetic. All patients breathed spontaneously through a Brain laryngeal mask. There were no clinically significant cardiovascular or respiratory differences between the two techniques.

Preoperative preparation for day surgery.

Day surgery is expanding in the UK. It offers benefits for both the patient and the NHS. If this initial momentum is to be maintained it is vital that patients are carefully selected and prepared for day case procedures.

Oral fluids prior to day surgery. The effect of shortening the pre-operative fluid fast on postoperative morbidity.

One hundred day surgical patients undergoing first trimester termination of pregnancy were randomly allocated to receive either 150 ml of clear fluid 1.5-2 hours before anaesthesia or to remain fasted from midnight the night before. Patients were anaesthetised using a total intravenous technique which consisted of propofol and alfentanil.

Propofol: bolus or continuous infusion. A day case technique for the vaginal termination of pregnancy.

Forty patients undergoing vaginal termination of pregnancy were randomly allocated to receive a propofol anaesthetic using either a repeat bolus or infusion technique. The Ohmeda 9000 Infusion Pump was used in the study. Patients in the infusion group recorded significantly longer induction times, greater maintenance doses and prolonged immediate recovery characteristics.

Recovery after day-case anaesthesia. A 24-hour comparison of recovery after thiopentone or propofol anaesthesia.

Sixty patients who presented for day-case dilatation and curettage were allocated randomly to receive either thiopentone or propofol for induction and maintenance of anaesthesia. One anaesthetist administered all the anaesthetics whilst all assessments were made by one other. The results indicate that early recovery of memory function, critical flicker fusion frequency and subjective feelings of tiredness, drowsiness and alertness were superior in the propofol group.

Prophylactic analgesia for daycase termination of pregnancy. A double-blind study with controlled release dihydrocodeine.

The incidence and severity of pain and nausea experienced by 40 primigravid day patients who presented for vaginal termination of pregnancy were examined. Controlled-release dihydrocodeine had no effect upon the incidence or severity of these minor sequelae. The requirements for escape analgesia and antiemetic therapy were less than anticipated and possible explanations are discussed.

Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements.

Fifty-two female patients who underwent gynaecological operations as day cases received either a short pre-operative hypnotic induction or a brief discussion of equal duration. Hypnotized patients who underwent vaginal termination of pregnancy required significantly less methohexitone for induction of anaesthesia. They were also significantly more relaxed as judged by their visual analogue scores for anxiety.

Which intravenous induction agent for day surgery? A comparison of propofol, thiopentone, methohexitone and etomidate.

Eighty day patients for the vaginal termination of pregnancy were randomly allocated to receive thiopentone, propofol, methohexitone or etomidate as intravenous induction agents. The same anaesthetist administered the anaesthesia and all the observers were blind to the agents used. The results show that thiopentone and propofol produced the least sequelae at induction and in recovery.

Temazepam and recovery in day surgery.

A double-blind trial of temazepam premedication for day cases was undertaken. Effective anxiolysis was recorded in the groups that received temazepam 10 or 20 mg and there was no prolongation of delayed recovery times as measured by memory test cards. All patients were discharged from the day unit 3 hours after the administration of general anaesthesia.

The workload of a purpose built day surgical unit.

The workload and utilisation of a purpose built day surgical unit at Addenbrooke's Hospital, Cambridge has been reviewed. Senior medical personnel are involved in the unit and 5071 operations were performed in the first two years. Despite a reduction of inpatient beds the surgical waiting lists have also decreased, we believe as a direct result of the day surgery programme.

Alfentanil and memory function. A comparison with fentanyl for day case termination of pregnancy.

Two groups of 20 patients undergoing day case vaginal termination of pregnancy received either methohexitone and alfentanil 7.5 micrograms/kg or methohexitone and fentanyl 1.5 micrograms/kg.

Day-case anaesthesia for termination of pregnancy. Evaluation of a total intravenous anaesthetic technique.

An investigation was undertaken to assess the use of a total intravenous anaesthetic technique of fentanyl and methohexitone for outpatient vaginal termination of pregnancy. When compared with a technique of fentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused swifter recovery, minimal side-effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia.

Day-case dental anaesthesia. Evaluation of pre-operative sublingual buprenorphine.

Sixty patients undergoing day-case dental surgery were either given sublingual buprenorphine 0.2 mg or 0.4 mg or a buffered placebo 1 hour prior to general anaesthesia.

Anaesthesia for myringotomy. The effect of nitrous oxide and intermittent positive pressure ventilation in children with secretory otitis media.

The effect of two methods of anaesthesia on the findings at myringotomy in children with secretory otitis media was studied. One group of patients spontaneously breathed a mixture of nitrous oxide, oxygen and halothane whereas a second group had assisted ventilation, tracheal intubation and breathed a mixture of halothane and oxygen. Nitrous oxide diffused significantly into middle ears which had gas under reduced pressure (with or without fluid present) when compared with normal ears (p less than 0.

Teaching anaesthetics to medical students. The design and evaluation of a course in a new clinical school.

The paper describes the rationale and implementation of anaesthetics teaching in the new 2 1/4-year clinical medical course at Cambridge University. A programme designed to monitor and evaluate the teaching established, and the results are reported. Significant improvements in students' knowledge of anaesthetics and their experience of practical procedures were noted, as compared to a control group.

Day case anaesthesia and memory.

Two simple anaesthetic techniques were administered to forty healthy women undergoing minor gynaecological surgery. There was a significantly shorter immediate recovery period following the use of a fentanyl and methohexitone technique. Memory function testing revealed an impairment of the ability to retain new information following anaesthesia.