Axonal sensitivity and block dynamics.

The role of differential nerve block in the development of analgesia after erector spinae plane block has been questioned. While highly myelinated nerves are more sensitive to local anesthetics than unmyelinated ones in vitro, factors influencing drug diffusion, particularly pKa, are more relevant in the clinical setting. Bupivacaine (the drug most used for an 'analgesic' effect) has a relatively high pKa (8.

James (Carrick) Moore (1763-1860): Another (Scottish) Local Anaesthetic Hero.

Modern technology has provided the author with access to a previously unobtainable publication, John Moore's 1784 work, ''. Not only did this allow direct consideration of his technique of nerve compression (which has been described briefly by many others since), but also showed that Moore had very advanced humane views on the need to try and produce pain relief for surgery. It also became possible to obtain far more information on the author, notably that although he worked in London he was born and educated in Glasgow, and did his initial medical training in Edinburgh.

W Harry Archer's collection of Horace Wells letters are still available. A commentary on a new publication.

The definitive account of the life and work of Horace Wells, the dentist from Hartford, Connecticut, who experimented with nitrous oxide anesthesia in 1844, is that published by W Harry Archer for the centenary of Wells's work. A major source of original material was a collection of letters, by Wells and others, that Archer found in the house in Hartford, Vermont, in which Wells was born. In later support for Wells being better recognized for his role in the introduction of general anaesthesia, Richard J Wolfe and Leonard F Menczer published a collection of essays in 1994.

The European Society of Regional Anaesthesia and Pain Therapy (1982-2012): 30 years strong.

Inspired by the earlier establishment of the American Society of Regional Anesthesia, but with a structure to accommodate the diverse languages and health care systems of Europe, the European Society of Regional Anaesthesia (ESRA) held its first scientific meeting in 1982. During the following 30 years, ESRA grew from strength to strength and implemented a number of important educational initiatives, the story of these developments being the subject of this review. ESRA's prime function is to publicize the evidence on regional anesthesia and encourage its further development, but it also led the way in democratizing European anesthesia societies by being the first to open its membership to all.

Some (mostly Scottish) local anaesthetic heroes.

In 1884 a young Viennese doctor, Carl Koller, was the first to recognise the significance of the topical effects of the alkaloid cocaine and thus introduced drug-induced local anaesthesia to clinical practice. Most subsequent development took place in Europe and the United States, with British interest not becoming apparent for over twenty years. This is surprising because a number of doctors working in Scotland, or with Scottish connections, had made important contributions to the earlier evolution of local anaesthetic techniques.

Sedation in a radiology department--do radiologists follow their own guidelines?

The Royal College of Radiologists (RCR) published guidelines in 2003 which aimed to standardise and improve the safety of sedation in the modern Radiology department. As sedation requirements increase, we decided to audit our own departments understandings and practice with respect to sedation. A repeat audit cycle was performed following a re-educational lecture, one year later.

Workers' exposure to dust, endotoxin and β-(1-3) glucan at four large-scale composting facilities.

Objectives: To characterise compost workers' exposure to dust, endotoxin and β-(1-3) glucan during various operational practices and investigate whether dust concentrations are a useful indicator of endotoxin exposure in compost workers.

Methods: This study assessed inhalable dust fractions, bacterial endotoxin and β-(1-3) glucan in 117 personal samples and 88 ambient samples from four large-scale composting facilities.

Results: Employees' exposures to inhalable dust, endotoxin and β-(1-3) glucan exhibited a large range.

Failed spinal anaesthesia: mechanisms, management, and prevention.

Although spinal (subarachnoid or intrathecal) anaesthesia is generally regarded as one of the most reliable types of regional block methods, the possibility of failure has long been recognized. Dealing with a spinal anaesthetic which is in some way inadequate can be very difficult; so, the technique must be performed in a way which minimizes the risk of regional block. Thus, practitioners must be aware of all the possible mechanisms of failure so that, where possible, these mechanisms can be avoided.

Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists.

Background: Serious complications of central neuraxial block (CNB) are rare. Limited information on their incidence and impact impedes clinical decision-making and patient consent. The Royal College of Anaesthetists Third National Audit Project was designed to inform this situation.

Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine.

Background: The aim of this study was to compare the clinical effects of 'hyperbaric' bupivacaine for spinal anaesthesia with those of similar preparations of levobupivacaine and ropivacaine.

Methods: Sixty ASA grade I-II patients undergoing elective surgery under spinal anaesthesia were randomized to receive 3 ml of bupivacaine, levobupivacaine, or ropivacaine, each at 5 mg ml(-1) and made hyperbaric by the addition of glucose 30 mg ml(-1). A standard protocol was followed after which a blinded observer assessed the sensory and motor blocks.