The Triservice Anaesthetic Apparatus: a review.

The Triservice Anaesthetic Apparatus was designed around 30 years ago as a robust and highly portable anaesthesia delivery system for medical support to airborne operations and it has been the core anaesthesia system for the Defence Medical Services since then. Over this period there have been a number of equipment changes but issues remain which are in part mitigated by recent training developments. This article reviews these changes and developments and considers the future of this equipment.

The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia.

BACKGROUND: Levobupivacaine, the S(-)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia. METHODS: A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and orbicularis oculi function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block. RESULTS: The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (P=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration vs time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group). CONCLUSIONS: Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects.

Who is watching over me?--was the public's perception of the anaesthetist changed by National Anaesthesia Day?

The aim of National Anaesthesia Day on 25 May 2000 was to inform the public about the role and training of anaesthetists. We carried out two surveys of patients attending Derriford Hospital, Plymouth to assess the local impact of National Anaesthesia Day and to assess the public's expectation of the preoperative visit. The first survey was held one month prior to National Anaesthesia Day and was completed by 93 patients. The second survey was held immediately following National Anaesthesia Day and was completed by 70 patients. Thirty five percent of the patients surveyed were unaware that anaesthetists were medically qualified. This result was not altered by National Anaesthesia Day despite a local information campaign. Moreover, knowledge about our role and training was only marginally improved from 1978. The majority of patients expected to see their anaesthetist preoperatively for less than 10 minutes and would not be concerned if they had not been seen one hour before surgery. Style of clothing was unimportant; few preferred a white coat but name badges were desirable. We conclude that the level of ignorance about our profession has not changed since 1978 and the impact of National Anaesthesia Day was not significant. This may be as a result of the anaesthetist's portrayal on television, which is known to be an important source of public information on other areas of medicine. If these statistics are to change in the next 22 years new methods of public education need to be found.

Recovery characteristics using single-breath 8% sevoflurane or propofol for induction of anaesthesia in day-case arthroscopy patients.

We studied the induction and recovery characteristics following inhalational induction with 8% sevoflurane in nitrous oxide and oxygen compared with intravenous propofol in 40 patients presenting for arthroscopy of the knee. Patients were randomly allocated to receive either induction agent, and anaesthesia was then maintained with sevoflurane in oxygen and nitrous oxide. A computerised test of hand--eye co-ordination and a p-deletion test were used to measure psychomotor recovery. The sevoflurane group had a faster onset of anaesthesia time. No significant differences between the groups were found in time to eye opening or psychomotor tests. Nausea and vomiting scores were significantly higher at 30 min in the sevoflurane group (p = 0.04); this difference was no longer significant by 90 min. We conclude that inhalational induction with sevoflurane in these patients has no important clinical advantages and causes more nausea and vomiting than propofol.